Healthcare Provider Details

I. General information

NPI: 1730729302
Provider Name (Legal Business Name): PATRICIA RANAYE MANN ATR, LPC, SAC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 S KINNICKINNIC AVE
MILWAUKEE WI
53207-1330
US

IV. Provider business mailing address

1830 E HOWARD AVE
SAINT FRANCIS WI
53235-4095
US

V. Phone/Fax

Practice location:
  • Phone: 414-419-1414
  • Fax:
Mailing address:
  • Phone: 414-419-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7083
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18862-130
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number18-141
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7083-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: