Provider Demographics
NPI:1639780943
Name:BUERGER, JACQUELINE PAIGE (LPC-I)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:PAIGE
Last Name:BUERGER
Suffix:
Gender:F
Credentials:LPC-I
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:FIEGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:E7475 RAWHIDE RD
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:WI
Mailing Address - Zip Code:54961-9025
Mailing Address - Country:US
Mailing Address - Phone:877-300-9101
Mailing Address - Fax:920-531-2686
Practice Address - Street 1:131 N ROLLING MEADOWS DR STE C
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54937-9482
Practice Address - Country:US
Practice Address - Phone:920-733-2065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YM0800X
101YP2500X
WI8515-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42251300Medicaid