Healthcare Provider Details

I. General information

NPI: 1144885609
Provider Name (Legal Business Name): ROSEZINA CAMPBELL OTHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROSEZINA CAMPBELL STUDENT

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 W CENTER ST
MILWAUKEE WI
53210-2154
US

IV. Provider business mailing address

4946 N 19TH ST
MILWAUKEE WI
53209-5759
US

V. Phone/Fax

Practice location:
  • Phone: 414-704-2751
  • Fax:
Mailing address:
  • Phone: 414-704-2751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12748-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: