Individual
PHOENIX VAN LAANEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
300 CROOKS ST, GREEN BAY, WI 54301-4527
(920) 436-6800
(920) 432-5966
Mailing address
2252 EASTMAN AVE, GREEN BAY, WI 54302-4674
(920) 680-4073
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
10207
WI
1041C0700X
Clinical Social Worker
Primary
10207
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10207
STATE LICENSE
WI
Enumeration date
08/06/2018
Last updated
06/04/2025
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