Provider Demographics
NPI:1356770986
Name:HELGESON, LISA M (MED, MA LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:HELGESON
Suffix:
Gender:F
Credentials:MED, MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:WI
Mailing Address - Zip Code:54002-0518
Mailing Address - Country:US
Mailing Address - Phone:715-928-1091
Mailing Address - Fax:
Practice Address - Street 1:1820 4TH AVE APT 1
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-5144
Practice Address - Country:US
Practice Address - Phone:715-928-1091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5950-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional