Provider Demographics
NPI:1679253371
Name:TRASSER, ELISE JENNIFER (LAC)
Entity type:Individual
Prefix:MS
First Name:ELISE
Middle Name:JENNIFER
Last Name:TRASSER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:341 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-5208
Mailing Address - Country:US
Mailing Address - Phone:262-501-4687
Mailing Address - Fax:
Practice Address - Street 1:394 WILLIAMSTOWNE STE 302
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2322
Practice Address - Country:US
Practice Address - Phone:262-501-4687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI903-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist