Healthcare Provider Details

I. General information

NPI: 1215892575
Provider Name (Legal Business Name): COURTNEY DAWN SLAK APSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 N GREEN BAY AVE STE 12
GLENDALE WI
53209-2800
US

IV. Provider business mailing address

N60W21630 LEGACY TRL
MENOMONEE FALLS WI
53051-7007
US

V. Phone/Fax

Practice location:
  • Phone: 414-216-3826
  • Fax:
Mailing address:
  • Phone: 414-216-3826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3001028238
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: