Healthcare Provider Details

I. General information

NPI: 1487196812
Provider Name (Legal Business Name): LISA MARIE REGNER M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 N MAYFAIR RD
MILWAUKEE WI
53222-2213
US

IV. Provider business mailing address

3800 N MAYFAIR RD
MILWAUKEE WI
53222-2213
US

V. Phone/Fax

Practice location:
  • Phone: 414-536-8333
  • Fax:
Mailing address:
  • Phone: 414-225-4460
  • Fax: 414-225-4475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7777-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: