Provider Demographics
NPI:1285835843
Name:KAUFMANN, SUE MARIE (MS)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:MARIE
Last Name:KAUFMANN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-5316
Mailing Address - Country:US
Mailing Address - Phone:507-474-0966
Mailing Address - Fax:
Practice Address - Street 1:N5589 COMMERCE RD
Practice Address - Street 2:STE.170A
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-9266
Practice Address - Country:US
Practice Address - Phone:507-474-0966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3310-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3310-125OtherLPC
WI39708300Medicaid
WI1241-121OtherADVANCED PRACTICE SW