Healthcare Provider Details

I. General information

NPI: 1205479698
Provider Name (Legal Business Name): NATALIE BOLTON SAC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7330 W LAYTON AVE
MILWAUKEE WI
53220-3849
US

IV. Provider business mailing address

7330 W LAYTON AVE
MILWAUKEE WI
53220-3849
US

V. Phone/Fax

Practice location:
  • Phone: 414-877-4570
  • Fax:
Mailing address:
  • Phone: 414-877-4570
  • Fax: 414-817-9840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1900-130
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8205
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: