Healthcare Provider Details

I. General information

NPI: 1215727987
Provider Name (Legal Business Name): HANNAH ROSE COFFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH ROSE MASARIK

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 N 124TH ST
BROOKFIELD WI
53005-2489
US

IV. Provider business mailing address

3505 N 124TH ST
BROOKFIELD WI
53005-2489
US

V. Phone/Fax

Practice location:
  • Phone: 414-431-4444
  • Fax: 414-431-0858
Mailing address:
  • Phone: 414-431-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12908-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: