Healthcare Provider Details

I. General information

NPI: 1508523770
Provider Name (Legal Business Name): UHO - YMCA OF METROPOLITAN MILWAUKEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7095 S BALLPARK DR STE 120
FRANKLIN WI
53132-6908
US

IV. Provider business mailing address

345 W SAINT PAUL AVE STE 2174
MILWAUKEE WI
53203-3099
US

V. Phone/Fax

Practice location:
  • Phone: 414-224-9622
  • Fax:
Mailing address:
  • Phone: 414-274-0708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: LISA COOMBS-GEROU
Title or Position: COO
Credential:
Phone: 414-274-0708