Provider Demographics
NPI:1619078193
Name:BEYER, CAROLYN (MSE)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:BEYER
Suffix:
Gender:F
Credentials:MSE
Other - Prefix:
Other - First Name:LYN
Other - Middle Name:BETH
Other - Last Name:SPORLEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSE
Mailing Address - Street 1:1532 S NICOLET RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-7510
Mailing Address - Country:US
Mailing Address - Phone:920-427-8420
Mailing Address - Fax:
Practice Address - Street 1:1532 S NICOLET RD
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-7510
Practice Address - Country:US
Practice Address - Phone:920-427-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2872-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39792700Medicaid