Provider Demographics
NPI:1740202944
Name:PULS, JOHN C (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:PULS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1176
Mailing Address - Country:US
Mailing Address - Phone:608-935-2776
Mailing Address - Fax:608-935-3174
Practice Address - Street 1:1122 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1176
Practice Address - Country:US
Practice Address - Phone:608-935-2776
Practice Address - Fax:608-935-3174
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1227-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39574800Medicaid
WI39574800Medicaid