Provider Demographics
NPI:1912147828
Name:SUQUET, EVANGELINE M (MAC, CSAC, LPC, CSIT)
Entity Type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:M
Last Name:SUQUET
Suffix:
Gender:F
Credentials:MAC, CSAC, LPC, CSIT
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 918
Mailing Address - Street 2:W9850 AIRPORT ROAD
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615
Mailing Address - Country:US
Mailing Address - Phone:715-284-9851
Mailing Address - Fax:715-284-3434
Practice Address - Street 1:W9850 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615
Practice Address - Country:US
Practice Address - Phone:715-284-9851
Practice Address - Fax:715-284-3434
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15705-132101YA0400X
WI5231-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health