MISS CARRIE DOMINICZAK (NPI# 1871075630) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871075630 |
| Entity Type | Individual |
| Full Name | MISS CARRIE DOMINICZAK |
| Credential | SACIT |
| Practice Address |
2357 W Mason St Green Bay WI 54303-4708 |
| Practice Telephone | 9203376740 |
| Practice Fax Number | 9203376741 |
| Mailing Telephone | 9203376740 |
| Mailing Fax Number | 9203376741 |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2018-08-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
18489-130 | WI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 42030700 | 05 |
| Street Address |
2357 W MASON ST |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54303-4708 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629282470 | Quality Addiction Management, Inc. | Counselor | 2357 W Mason St, Green Bay, WI 54303-4708 | 2007-05-10 |
| 1902423528 | Jenna Price | Registered Nurse | 2357 W Mason St, Green Bay, WI 54303-4708 | 2020-06-30 |
| 1366069973 | Nicole Luchterhand | Counselor | 2357 W Mason St, Green Bay, WI 54303-4708 | 2020-06-30 |
| 1295361566 | Tyler Webb | Counselor | 2357 W Mason St, Green Bay, WI 54303-4708 | 2020-03-19 |
| 1285274688 | Jaden Hendzel | Counselor | 2357 W Mason St, Green Bay, WI 54303-4708 | 2020-01-14 |
| 1588218093 | Angel Anderson | Counselor | 2357 W Mason St, Green Bay, WI 54303-4708 | 2019-08-01 |
| 1417512435 | Stacey Van Schyndel | Licensed Practical Nurse | 2357 W Mason St, Green Bay, WI 54303-4708 | 2019-05-06 |
| 1861957714 | Jillian Scott | Counselor | 2357 W Mason St, Green Bay, WI 54303-4708 | 2019-02-05 |
| 1588133698 | Cortlee Plass | Counselor | 2357 W Mason St, Green Bay, WI 54303-4708 | 2018-11-19 |
| 1669940730 | Carrie Quinnell | Licensed Practical Nurse | 2357 W Mason St, Green Bay, WI 54303-4708 | 2018-11-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952921033 | Ashley Marie Vandermoss | Social Worker | 1601 W Mason Street, Green Bay, WI 54303 | 2020-04-20 |
| 1598307423 | Jean Marie Castaneda | Case Manager/Care Coordinator | 2517 N. Court, Green Bay, WI 54303 | 2019-10-11 |
| 1215579552 | Integrated Treatment Centers, LLC | Clinic/Center | 2311 W Mason Street, Green Bay, WI 54303 | 2019-10-08 |
| 1003460551 | Affordable Dentures & Implants - Green Bay, S.c. | Dentist | 1800-c W. Mason Street, Green Bay, WI 54303 | 2019-08-01 |
| 1164940375 | Kaeley Rae Blaney | Student in an Organized Health Care Education/Training Program | 2088 Memorial Drive #208, Green Bay, WI 54303 | 2017-09-07 |
| 1518498047 | Treatment Providers LLC | Clinic/Center | 2731 N Packerland Dr Ste A, Green Bay, WI 54303 | 2017-03-26 |
| 1851840565 | Back To Balance Chiropractic, LLC | Chiropractor | 110 Packerland Drive, Suite B, Green Bay, WI 54303 | 2016-09-23 |
| 1710361001 | Matthew Lemay | Acupuncturist | 727 E Walnut, Suite B2, Green Bay, WI 54303 | 2015-07-16 |
| 1144600149 | Carrie Jean Banaszak | Counselor | 1039 Mason Street, Green Bay, WI 54303 | 2015-06-04 |
| 1174921993 | Kensey Meyer | Occupational Therapy Assistant | 1555 Dousman Road, Seymour, WI 54303 | 2014-12-10 |
| Find all providers in zip 54303 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821659624 | The Salvation Army | Counselor | The Salvation Army Ray & Joan Kroc Center, 1315 Lime Kiln Road, Green Bay, WI 54311 | 2019-06-24 |
| 1821522889 | Wayne Borowitz | Counselor | 621 E Walnut St, Green Bay, WI 54301-4001 | 2017-04-17 |
| 1427421023 | Katie Koebernik | Counselor | 424 S Monroe Ave Ste 201, Green Bay, WI 54301-4054 | 2015-11-04 |
| 1386041598 | Andrea Bonnin | Counselor | 2979 Allied St Ste C, Green Bay, WI 54304-5567 | 2014-12-03 |
| 1649671421 | Heather Marie Novak | Counselor | 2979 Allied St Unit C, Green Bay, WI 54304 | 2014-09-11 |
| 1962816371 | Joelle M Hesse | Counselor | 630 Cherry St., Green Bay, WI 54301 | 2014-06-13 |
| 1790016467 | Deborah J Hauser | Counselor | 3150 Gershwin, Green Bay, WI 54311-5859 | 2010-01-20 |
| 1336372259 | Edwin A Chrisman | Counselor | 331 S Adams St, Green Bay, WI 54301-4515 | 2009-08-26 |
| 1457585614 | Adam Miles Sturdevant | Counselor | 1049 Dousman St, Green Bay, WI 54303-3003 | 2009-05-04 |
| 1659538361 | Regina E Cuellar-proctor | Counselor | 3150 Gershwin Dr, Green Bay, WI 54311-4328 | 2008-05-20 |
| Find all providers in GREEN BAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.