Doctor Name: | ROBERTA J CARLSON |
NPI Number: | 1033353289 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS |
License Number: | |
Business Practice Address: | 100 Polk County Plz Suite 50 Balsam Lake, WI - 548109071 |
Business Phone Number: | 7154858465 |
Business Fax Number: | 7154858490 |
Mailing Address: | 2028 100th St, SOMERSET |
State: | WI |
Postal Code: | 540257550 |
Phone Number: | 7152460304 |
Fax Number: | |
NPI Enumeration Date: | 04/30/2009 |
NPI Last Update Date: | 05/05/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |