Healthcare Provider Details

I. General information

NPI: 1003592171
Provider Name (Legal Business Name): JAMIE LYAN TEISSONNIERE RAMIREZ APSW, SAC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S 6TH ST
MILWAUKEE WI
53204-2301
US

IV. Provider business mailing address

1529 S 12TH ST
MILWAUKEE WI
53204-2735
US

V. Phone/Fax

Practice location:
  • Phone: 414-643-8530
  • Fax:
Mailing address:
  • Phone: 414-522-3316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20056-130
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number135111-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: