Healthcare Provider Details

I. General information

NPI: 1932397528
Provider Name (Legal Business Name): CINDY MILNER CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 E BRADY ST
MILWAUKEE WI
53202
US

IV. Provider business mailing address

1228 E BRADY ST
MILWAUKEE WI
53202
US

V. Phone/Fax

Practice location:
  • Phone: 414-278-8513
  • Fax: 414-278-0726
Mailing address:
  • Phone: 414-278-8513
  • Fax: 414-278-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2270123
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2270-123
License Number StateWI

VIII. Authorized Official

Name: MS. CYNTHIA VEE MILNER
Title or Position: DIRECTOR
Credential: LCSW
Phone: 414-278-8513