Healthcare Provider Details

I. General information

NPI: 1306256474
Provider Name (Legal Business Name): ANDREA M ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 W. FLORIST AVE #125
GLENDALE WI
53209
US

IV. Provider business mailing address

1720 W. FLORIST AVE #125
GLENDALE WI
53209-3864
US

V. Phone/Fax

Practice location:
  • Phone: 414-247-0801
  • Fax: 414-247-0816
Mailing address:
  • Phone: 414-247-0801
  • Fax: 414-247-0816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1914-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: