Individual
VERONICA M ELLINGWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPC, SAC, ICS
Contact information
Practice address
100 BUSINESS PARK CIR STE 202, STOUGHTON, WI 53589-5501
(608) 695-0960
Mailing address
204 E HUBERT ST, EDGERTON, WI 53534-1318
(608) 695-0960
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
6410-125
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
16161-131
WI
101YM0800X
Mental Health Counselor
Primary
6410-125
WI
101YP2500X
Professional Counselor
6410-125
WI
Other
Enumeration date
09/26/2017
Last updated
04/02/2024
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