MEDICARE: VERONICIA S GREEN

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	18955-130	WI

General Provider Information

NPI Number	:	1649879982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICIA S GREEN

Provider Business Mailing Address
First Line	:	1350 N 55TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-2101
Country	:	US
Telephone Number	:	414-334-0630
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 N VEL R PHILLIPS AVE STE 131
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2370
Country	:	US
Telephone Number	:	414-431-8322
Fax Number	:

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

Provider Enumeration Date	:	10/19/2020
Last Update Date	:	10/19/2020

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Directions to “ VERONICIA S GREEN ” Practice Location

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