Healthcare Provider Details

I. General information

NPI: 1831108851
Provider Name (Legal Business Name): LEE MARGARET SKUPNIEWITZ APSW MSSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEE MARGARET PEASE

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 S 70TH STREET
MILWAUKEE WI
53214-3164
US

IV. Provider business mailing address

1040 S 70TH STREET
MILWAUKEE WI
53214-3164
US

V. Phone/Fax

Practice location:
  • Phone: 414-476-9675
  • Fax: 414-615-0627
Mailing address:
  • Phone: 414-476-9675
  • Fax: 414-615-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2155121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: