Provider Demographics
NPI:1982680005
Name:KREBSBACH, JOSEPH A (BSW, CADC III)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:KREBSBACH
Suffix:
Gender:M
Credentials:BSW, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 BELMAR PL
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-1146
Mailing Address - Country:US
Mailing Address - Phone:920-743-1599
Mailing Address - Fax:
Practice Address - Street 1:421 NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-2249
Practice Address - Country:US
Practice Address - Phone:920-746-2345
Practice Address - Fax:920-746-2439
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1468101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)