Individual
RICKELLE AUDRIS OPGENORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1216 MARK AVE, TOMAH, WI 54660-1199
(608) 377-7487
Mailing address
1216 MARK AVE, TOMAH, WI 54660-1199
(608) 377-7487
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
4829-26
WI
101YM0800X
Mental Health Counselor
Primary
10692-125
WI
101YP2500X
Professional Counselor
4829-226
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
473326066
—
WI
Enumeration date
01/09/2020
Last updated
08/20/2024
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