Healthcare Provider Details

I. General information

NPI: 1083810634
Provider Name (Legal Business Name): MARILYN ANN METZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3953 N 76TH ST SUITE 305
MILWAUKEE WI
53222-3059
US

IV. Provider business mailing address

6540 W ENGLISH MEADOWS DR J203
GREENFIELD WI
53220-5405
US

V. Phone/Fax

Practice location:
  • Phone: 414-616-2292
  • Fax: 414-616-2296
Mailing address:
  • Phone: 414-727-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number109-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: