Facts
- Status
- A
- Credential
- LCSW, SAC-T
- Type
- Individual
- Enumeration date
- 2012-02-21
- Last updated
- 2013-04-17
Licenses
- License WI
- 7889-123
- License WI
- 16529-130
Location
- Practice location
- 3173 SHERMAN PARC CIR
- City
- JACKSON WI
- Postal code
- 530378954
- Phone
- 414-491-2140
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.