Individual
PAULINE W VANDENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1810 APPLETON ROAD, MENASHA, WI 54952
(920) 939-4226
(920) 739-7639
Mailing address
1810 APPLETON ROAD, MENASHA, WI 54952
(920) 939-4226
(920) 739-7639
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3029125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43554100
—
WI
Enumeration date
01/30/2007
Last updated
06/04/2009
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