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NPI Code Detail

MEDICARE: MR. TRAVIS JAY TROTT LCSW

MEDICARE: MR. TRAVIS JAY TROTT LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149017843IL
21041C0700XClinical Social Worker8447123WI

General Provider Information

NPI Number : 1003162983
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TRAVIS JAY TROTT LCSW
Provider Business Mailing Address
First Line : 1841 N PROSPECT AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-1933
Country : US
Telephone Number : 773-993-8708
Fax Number :
Provider Business Practice Location Address
First Line : 1841 N PROSPECT AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-1933
Country : US
Telephone Number : 773-993-8708
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2012
Last Update Date : 04/01/2017

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