Basic Information
| Provider Information | |||||||||
| NPI: | 1548309941 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BITNER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CSAC, ICS II | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3953 CARL ST | ||||||||
| Address2: | |||||||||
| City: | WAUSAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544032286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155811981 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1218 N 4TH ST | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | TOMAHAWK | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544872135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152242100 | ||||||||
| FaxNumber: | 7152242106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 11/05/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 11555 - 132 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 393803000 | 05 | WI | MEDICAID |