| NPI | 1104009414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY R LUND Clinical Social Worker 262-787-2904 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 2774-123) |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2007-12-10 |