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1457858136
CONNIE O MADLOCK
MILWAUKEE, WI
NPI
1457858136
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WI 16826-130)
Enumeration Date
2018-04-10
Last Update Date
2018-04-10
Business Address
CONNIE O MADLOCK
3707 N RICHARDS ST
MILWAUKEE, WI 53212-1673
Phone number: 414-967-7006
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Mailing Address
CONNIE O MADLOCK
3707 N RICHARDS ST
MILWAUKEE, WI 53212-1673
Phone number: 414-967-7006
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