MEDICARE: LINDA A. ZACHARIAS APSW

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	104100000X	Social Worker	127105121	WI
2	1041C0700X	Clinical Social Worker	7705-123	WI

General Provider Information

NPI Number	:	1134264369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA A. ZACHARIAS APSW

Provider Business Mailing Address
First Line	:	634 W HISTORIC MITCHELL ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-3512
Country	:	US
Telephone Number	:	414-383-4486
Fax Number	:	414-383-4522

Provider Business Practice Location Address
First Line	:	12630 W NORTH AVE BLDG E
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-4626
Country	:	US
Telephone Number	:	262-785-1008
Fax Number	:

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	02/07/2020

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