Provider Demographics
NPI:1689919284
Name:PANNEBAKER, DENISE STAR (LPC-IT)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:STAR
Last Name:PANNEBAKER
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 N RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-1148
Mailing Address - Country:US
Mailing Address - Phone:920-730-1324
Mailing Address - Fax:920-734-2824
Practice Address - Street 1:3003 N RICHMOND ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1148
Practice Address - Country:US
Practice Address - Phone:920-730-1324
Practice Address - Fax:920-734-2824
Is Sole Proprietor?:No
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1526-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional