Provider Demographics
NPI:1700985512
Name:BREITUNG, JOEL E (MSW)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:E
Last Name:BREITUNG
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2956 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHETEK
Mailing Address - State:WI
Mailing Address - Zip Code:54728-9532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2661 COUNTY HIGHWAY I
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5407
Practice Address - Country:US
Practice Address - Phone:715-723-5585
Practice Address - Fax:715-726-3504
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0024Medicare ID - Type Unspecified
39505400Medicare ID - Type Unspecified