Individual
MASON E VANROSSUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
480 PILGRIM WAY # 1300-A, GREEN BAY, WI 54304-5280
(920) 610-5119
(920) 610-5120
Mailing address
1900 SILVER LAKE RD NW STE 110, NEW BRIGHTON, MN 55112-1789
(651) 628-9566
(651) 628-0411
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
11795
WI
103TC1900X
Counseling Psychologist
7475-226
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100277298
—
WI
Enumeration date
05/22/2024
Last updated
11/26/2025
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