MEDICARE: AIESHA GOLDEN

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
1	101YP2500X	Professional Counselor		WI

General Provider Information

NPI Number	:	1063818060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIESHA GOLDEN

Provider Business Mailing Address
First Line	:	5210 MILWAUKEE ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53714-2115
Country	:	US
Telephone Number	:	608-807-7967
Fax Number	:

Provider Business Practice Location Address
First Line	:	5210 MILWAUKEE ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53714-2115
Country	:	US
Telephone Number	:	608-807-7967
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2014
Last Update Date	:	11/18/2014

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Directions to “ AIESHA GOLDEN ” Practice Location

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