Provider Demographics
NPI:1861615759
Name:RAECK, DEBRA J (MS, LPC, SAC-IT)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:J
Last Name:RAECK
Suffix:
Gender:F
Credentials:MS, LPC, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W209 N13497 ROBINHOOD DR.
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53076
Mailing Address - Country:US
Mailing Address - Phone:262-628-0428
Mailing Address - Fax:262-628-0428
Practice Address - Street 1:6040 W. LISBON AVE., SUITE 200
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210
Practice Address - Country:US
Practice Address - Phone:414-447-9890
Practice Address - Fax:474-447-9891
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13486-130101YA0400X
WI3903-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43719800Medicaid