Healthcare Provider Details

I. General information

NPI: 1720950751
Provider Name (Legal Business Name): MARGARET RUSSELL LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 N 60TH ST
MILWAUKEE WI
53208-1641
US

IV. Provider business mailing address

1922 N PALMER ST APT 5
MILWAUKEE WI
53212-3757
US

V. Phone/Fax

Practice location:
  • Phone: 414-771-2881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8718-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: