Healthcare Provider Details

I. General information

NPI: 1033028170
Provider Name (Legal Business Name): CERENA MATTHAEUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N14W23777 STONE RIDGE DR STE 290
WAUKESHA WI
53188-1140
US

IV. Provider business mailing address

1625 E NORWICH AVE
SAINT FRANCIS WI
53235-4615
US

V. Phone/Fax

Practice location:
  • Phone: 414-667-5809
  • Fax: 262-393-2462
Mailing address:
  • Phone: 414-736-6818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9270-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: