Healthcare Provider Details

I. General information

NPI: 1811812621
Provider Name (Legal Business Name): BOBBY N/A TRIPLETT APSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2063 S 77TH ST
WEST ALLIS WI
53219-1112
US

IV. Provider business mailing address

2063 S 77TH ST
WEST ALLIS WI
53219-1112
US

V. Phone/Fax

Practice location:
  • Phone: 414-839-2914
  • Fax:
Mailing address:
  • Phone: 414-839-2914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number135369121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: