Healthcare Provider Details

I. General information

NPI: 1417386012
Provider Name (Legal Business Name): MAKE A DIFFERENCE EVERYDAY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 N 68TH ST SUITE 205
MILWAUKEE WI
53216-2066
US

IV. Provider business mailing address

PO BOX 91862
MILWAUKEE WI
53209-8862
US

V. Phone/Fax

Practice location:
  • Phone: 414-722-3274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: LEKEYA LEE
Title or Position: DIRECTOR
Credential:
Phone: 414-722-3274