Healthcare Provider Details

I. General information

NPI: 1548988785
Provider Name (Legal Business Name): EMMA SMITH-KNAPP LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMMA SMITH LPC

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 N CASS ST STE 3
MILWAUKEE WI
53202-2770
US

IV. Provider business mailing address

4411 W CUSTER AVE
MILWAUKEE WI
53218-3434
US

V. Phone/Fax

Practice location:
  • Phone: 414-291-9487
  • Fax: 414-291-9975
Mailing address:
  • Phone: 414-376-0673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5405-226
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11410-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: