| 19place | |
|
4039 N 19th Pl Milwaukee WI 53209-6806 | |
| (414) 630-4986 | |
| Not Available |
| Full Name | 19place |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 4039 N 19th Pl, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Dorothy Ree Mccollum (OWNER/DIRECTOR) |
| Authorized Official Contact | 4146304986 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 19place 4039 N 19th Pl Milwaukee WI 53209-6806 Ph: (414) 630-4986 | 19place 4039 N 19th Pl Milwaukee WI 53209-6806 Ph: (414) 630-4986 |
| NPI Number | 1538685854 |
|---|---|
| Provider Enumeration Date | 08/17/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538685854 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | 8345-123 (Wisconsin) | Primary |
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