Individual
BETH ANN BURNSIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3150 GERSHWIN DR, GREEN BAY, WI 54311-4328
(920) 391-4700
(920) 391-4731
Mailing address
374 S PECK AVE, PESHTIGO, WI 54157-1511
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16447
WI
Other
Enumeration date
02/06/2019
Last updated
07/27/2021
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