Healthcare Provider Details

I. General information

NPI: 1760720932
Provider Name (Legal Business Name): LAURA CECCATO MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA SWAAB MS, LPC

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 DEWEY AVE BUILDING #11, DEWEY CENTER
WAUWATOSA WI
53213-2504
US

IV. Provider business mailing address

3301 W FOREST HOME AVE
MILWAUKEE WI
53215-2843
US

V. Phone/Fax

Practice location:
  • Phone: 414-454-6633
  • Fax: 414-454-6747
Mailing address:
  • Phone: 414-389-2377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15831-131
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4906-125
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4906-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: