Healthcare Provider Details

I. General information

NPI: 1720993405
Provider Name (Legal Business Name): MARLENE WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 W CAPITOL DR
MILWAUKEE WI
53216-2530
US

IV. Provider business mailing address

4001 W CAPITOL DR
MILWAUKEE WI
53216-2530
US

V. Phone/Fax

Practice location:
  • Phone: 404-590-1225
  • Fax:
Mailing address:
  • Phone: 404-590-1225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number136304-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: