Healthcare Provider Details

I. General information

NPI: 1356551493
Provider Name (Legal Business Name): MRS. CATHERIN CARR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 N 4TH ST SUITE 516
MILWAUKEE WI
53212-2362
US

IV. Provider business mailing address

8544 N 56TH ST
BROWN DEER WI
53223-3022
US

V. Phone/Fax

Practice location:
  • Phone: 414-263-6000
  • Fax: 414-263-2270
Mailing address:
  • Phone: 414-263-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14205-130
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: