Healthcare Provider Details

I. General information

NPI: 1205579919
Provider Name (Legal Business Name): CHEYENNE MORRIS APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHEYENNE FITZGERALD APSW

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 04/20/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S BLOUNT ST STE 103
MADISON WI
53703-4664
US

IV. Provider business mailing address

6715 FAIRHAVEN RD
MADISON WI
53719-6220
US

V. Phone/Fax

Practice location:
  • Phone: 608-405-5111
  • Fax: 608-554-1052
Mailing address:
  • Phone: 815-922-4255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number131880-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: