Healthcare Provider Details

I. General information

NPI: 1154656569
Provider Name (Legal Business Name): ELEENA HARDZINSKI LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2009
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 W BROWN DEER RD SUITE 200
BROWN DEER WI
53209-1220
US

IV. Provider business mailing address

861 KIMBALL LN UNIT 105
VERONA WI
53593-1793
US

V. Phone/Fax

Practice location:
  • Phone: 414-540-2170
  • Fax:
Mailing address:
  • Phone: 608-354-3584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number824124
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: