Basic Information
| Provider Information | |||||||||
| NPI: | 1356658439 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUEGE | ||||||||
| FirstName: | EILENE | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NYQUIST | ||||||||
| OtherFirstName: | EILENE | ||||||||
| OtherMiddleName: | S | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6800 N 76TH ST | ||||||||
| Address2: | PO BOX 245039 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532235002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143686070 | ||||||||
| FaxNumber: | 4143686073 | ||||||||
| Practice Location | |||||||||
| Address1: | 6800 N 76TH ST | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532235002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143686070 | ||||||||
| FaxNumber: | 4143686073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2010 | ||||||||
| LastUpdateDate: | 09/09/2010 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 587-226 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.