Provider Demographics
NPI:1013326289
Name:PRIESTAF, EMILY (LPC, MT-BC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:PRIESTAF
Suffix:
Gender:F
Credentials:LPC, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 S HIGH POINT RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4926
Mailing Address - Country:US
Mailing Address - Phone:406-799-9386
Mailing Address - Fax:
Practice Address - Street 1:1320 BUENA VISTA DR
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-1896
Practice Address - Country:US
Practice Address - Phone:608-834-7522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225A00000X
WI7199-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist