Healthcare Provider Details

I. General information

NPI: 1912236324
Provider Name (Legal Business Name): MAUREEN S FOLEY CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2314 N GRANDVIEW BLVD SUITE 301 & 110
WAUKESHA WI
53188-1675
US

IV. Provider business mailing address

285 N JANACEK RD
BROOKFIELD WI
53045-6102
US

V. Phone/Fax

Practice location:
  • Phone: 262-524-9416
  • Fax: 262-524-9434
Mailing address:
  • Phone: 262-641-9050
  • Fax: 262-641-9126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11301-132
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: