Provider Demographics
NPI:1811486913
Name:ARNESON, EDIE ELLEN
Entity type:Individual
Prefix:MS
First Name:EDIE
Middle Name:ELLEN
Last Name:ARNESON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15434 COUNTY HIGHWAY A
Mailing Address - Street 2:
Mailing Address - City:VIOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54664-8922
Mailing Address - Country:US
Mailing Address - Phone:608-438-4141
Mailing Address - Fax:
Practice Address - Street 1:165 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2253
Practice Address - Country:US
Practice Address - Phone:608-521-0553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7508-125101YM0800X
WI3132-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional