Healthcare Provider Details

I. General information

NPI: 1477513588
Provider Name (Legal Business Name): JESSICA JOAN SUHR LSCW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16535 W BLUEMOUND RD STE 200
BROOKFIELD WI
53005-5906
US

IV. Provider business mailing address

4044 S 76TH ST
MILWAUKEE WI
53220-2323
US

V. Phone/Fax

Practice location:
  • Phone: 262-789-1191
  • Fax: 262-821-6180
Mailing address:
  • Phone: 414-791-6961
  • Fax: 262-821-6180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number343-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: