Provider Demographics
NPI:1912100298
Name:PLEUSS, PHYLLIS ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:ANN
Last Name:PLEUSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 BLUE RIDGE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2418
Mailing Address - Country:US
Mailing Address - Phone:608-827-5698
Mailing Address - Fax:
Practice Address - Street 1:1200 NORTH CENTER STREET
Practice Address - Street 2:LUTHERAN SOCIAL SERVICES
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916
Practice Address - Country:US
Practice Address - Phone:920-887-3172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI61171231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical