Provider Demographics
NPI:1710150768
Name:BUELOW, CHARMAINE LOU (LPC)
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:LOU
Last Name:BUELOW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:WI
Mailing Address - Zip Code:54162-0216
Mailing Address - Country:US
Mailing Address - Phone:920-822-1867
Mailing Address - Fax:920-822-1867
Practice Address - Street 1:141 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:WI
Practice Address - Zip Code:54162-8842
Practice Address - Country:US
Practice Address - Phone:920-822-1867
Practice Address - Fax:920-822-1867
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2769-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40970500Medicaid