Healthcare Provider Details

I. General information

NPI: 1740157080
Provider Name (Legal Business Name): LEGACIES FAMILY DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3044 S 92ND ST
WEST ALLIS WI
53227-3678
US

IV. Provider business mailing address

3044 S 92ND ST
WEST ALLIS WI
53227-3678
US

V. Phone/Fax

Practice location:
  • Phone: 262-693-6021
  • Fax:
Mailing address:
  • Phone: 262-693-6021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: JAZZMIN DIXON
Title or Position: OWNER
Credential:
Phone: 262-693-6021