Healthcare Provider Details

I. General information

NPI: 1699885103
Provider Name (Legal Business Name): CHRISTINE M. PEDRETTI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE M. KNOX

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/17/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N7265 COLBO RD
BURLINGTON WI
53105-2525
US

IV. Provider business mailing address

N7265 COLBO RD
BURLINGTON WI
53105-2525
US

V. Phone/Fax

Practice location:
  • Phone: 414-550-3920
  • Fax:
Mailing address:
  • Phone: 414-550-3920
  • Fax: 608-756-0174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number624123
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number624-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: