| Change 4 Children Services, Llc | |
|
2266 N Prospect Ave 605 Milwaukee WI 53202-6319 | |
| (414) 289-0937 | |
| (414) 289-0938 |
| Full Name | Change 4 Children Services, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 2266 N Prospect Ave, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Theresa T Boswell (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4142890937 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Change 4 Children Services, Llc 2266 N Prospect Ave 605 Milwaukee WI 53202-6319 Ph: (414) 289-0937 | Change 4 Children Services, Llc 2266 N Prospect Ave 605 Milwaukee WI 53202-6319 Ph: (414) 289-0937 |
| NPI Number | 1730338286 |
|---|---|
| Provider Enumeration Date | 09/09/2008 |
| Last Update Date | 09/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730338286 | NPI | - | NPPES |
| 42239100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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