Provider Demographics
NPI:1013285006
Name:BRUEGGEN, KATIE L (MS, LMFT)
Entity type:Individual
Prefix:MS
First Name:KATIE
Middle Name:L
Last Name:BRUEGGEN
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 S 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3930
Mailing Address - Country:US
Mailing Address - Phone:855-607-8242
Mailing Address - Fax:
Practice Address - Street 1:630 S 36TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3930
Practice Address - Country:US
Practice Address - Phone:855-607-8242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI891-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist