Healthcare Provider Details

I. General information

NPI: 1780238253
Provider Name (Legal Business Name): NIAJCIA BROOKSHIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8248 W WINFIELD AVE
MILWAUKEE WI
53218-1049
US

IV. Provider business mailing address

8248 W WINFIELD AVE
MILWAUKEE WI
53218-1049
US

V. Phone/Fax

Practice location:
  • Phone: 414-540-2170
  • Fax:
Mailing address:
  • Phone: 414-540-2170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4435-226
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8550
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: