Provider Demographics
NPI:1821338765
Name:PULLEN, ANNETTE (LADC AND LPCC, LPC)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:PULLEN
Suffix:
Gender:F
Credentials:LADC AND LPCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N9705 VIOLET LN
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-1179
Mailing Address - Country:US
Mailing Address - Phone:651-380-2235
Mailing Address - Fax:
Practice Address - Street 1:15561 RAILROAD ST STE 203A
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-5703
Practice Address - Country:US
Practice Address - Phone:651-347-1380
Practice Address - Fax:651-347-1380
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302869101YA0400X
WI10255-125101YP2500X
MN01151101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)