Healthcare Provider Details

I. General information

NPI: 1336785336
Provider Name (Legal Business Name): SELENA L LETTEER LPC, CSAC, ICS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10427 W LINCOLN AVE STE 1800
WEST ALLIS WI
53227-1200
US

IV. Provider business mailing address

7957 W WIND LAKE RD STE E
WATERFORD WI
53185-2234
US

V. Phone/Fax

Practice location:
  • Phone: 414-361-2261
  • Fax: 262-895-2291
Mailing address:
  • Phone: 608-561-8656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18405-130
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7262-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: