Healthcare Provider Details

I. General information

NPI: 1750547964
Provider Name (Legal Business Name): SUSAN J MCALEY MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 30TH AVE SUITE 202
KENOSHA WI
53144-1632
US

IV. Provider business mailing address

285 N JANACEK RD
BROOKFIELD WI
53045-6102
US

V. Phone/Fax

Practice location:
  • Phone: 262-842-0500
  • Fax: 262-842-0502
Mailing address:
  • Phone: 262-641-9050
  • Fax: 262-641-9126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4081-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: