Provider Demographics
NPI:1174857312
Name:RURAL EMPLOYEE AND STUDENT ASSISTANCE PROFESSIONALS, INC.
Entity Type:Organization
Organization Name:RURAL EMPLOYEE AND STUDENT ASSISTANCE PROFESSIONALS, INC.
Other - Org Name:RESAP, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KNUTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW
Authorized Official - Phone:715-281-1541
Mailing Address - Street 1:40 JEWELERS PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3702
Mailing Address - Country:US
Mailing Address - Phone:715-281-1541
Mailing Address - Fax:920-720-9980
Practice Address - Street 1:40 JEWELERS PARK DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956
Practice Address - Country:US
Practice Address - Phone:715-281-1541
Practice Address - Fax:920-720-9980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI625-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39256200Medicaid
WI1205960077OtherNPI