Individual
CONNIE RAE CHAMPION
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW, LPC-IT, SAC-IT
Contact information
Practice address
414 BROADWAY ST STE 101, BARABOO, WI 53913-2488
(608) 402-4312
Mailing address
5900 MONONA DR STE 300, MONONA, WI 53716-3561
(608) 663-2120
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18546
WI
101YP2500X
Professional Counselor
3265
WI
Other
Enumeration date
04/23/2018
Last updated
04/23/2018
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