Provider Demographics
NPI:1649620725
Name:DEGRAW, PRAIRIE L (LPC)
Entity type:Individual
Prefix:
First Name:PRAIRIE
Middle Name:L
Last Name:DEGRAW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 S. RIVER ST.
Mailing Address - Street 2:SUITE 254
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-3863
Mailing Address - Country:US
Mailing Address - Phone:608-755-5260
Mailing Address - Fax:608-755-5267
Practice Address - Street 1:17 S. RIVER ST.
Practice Address - Street 2:SUITE 254
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-3863
Practice Address - Country:US
Practice Address - Phone:608-755-5260
Practice Address - Fax:608-755-5267
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3064226101YA0400X
WI7446101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)