Healthcare Provider Details

I. General information

NPI: 1679065593
Provider Name (Legal Business Name): YOUNG MEN'S CHRISTIAN ASSOCIATION OF METROPOLITAN MILWAUKEE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 WEST WISCONSIN AVENUE, SUITE 4000
MILWAUKEE WI
53203-2601
US

IV. Provider business mailing address

161 WEST WISCONSIN AVE. SUITE 4000
MILWAUKEE WI
53203-2601
US

V. Phone/Fax

Practice location:
  • Phone: 414-224-9622
  • Fax: 414-224-3323
Mailing address:
  • Phone: 414-224-9622
  • Fax: 414-224-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MS. CARRIE WALL
Title or Position: PRESIDENT/CEO
Credential:
Phone: 414-274-0711