Healthcare Provider Details

I. General information

NPI: 1407628167
Provider Name (Legal Business Name): VICTORIA DUCOFFE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10437 W INNOVATION DR STE 333
WAUWATOSA WI
53226-4838
US

IV. Provider business mailing address

10437 W INNOVATION DR STE 333
WAUWATOSA WI
53226-4838
US

V. Phone/Fax

Practice location:
  • Phone: 414-800-8601
  • Fax:
Mailing address:
  • Phone: 414-800-8601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11398-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: