Healthcare Provider Details

I. General information

NPI: 1154138964
Provider Name (Legal Business Name): PCL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 02/04/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 W BURLEIGH ST # 2000
MILWAUKEE WI
53210-1516
US

IV. Provider business mailing address

5800 W BURLEIGH ST # 2000
MILWAUKEE WI
53210-1516
US

V. Phone/Fax

Practice location:
  • Phone: 920-917-2189
  • Fax:
Mailing address:
  • Phone: 920-917-2189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: PA CHEE LEE
Title or Position: OWNER
Credential:
Phone: 920-917-2189