Individual
SALLY BARDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
101 BROAD ST STE 201, LAKE GENEVA, WI 53147-2061
(262) 248-7942
(262) 248-1202
Mailing address
1116 ROYAL BIRKDALE CT, LAKE GENEVA, WI 53147-5013
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3762-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43715500
—
WI
Enumeration date
03/13/2007
Last updated
07/08/2007
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