Healthcare Provider Details

I. General information

NPI: 1598865669
Provider Name (Legal Business Name): LARRY E HOPWOOD LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W RIVER DRIVE
WEST BEND WI
53090
US

IV. Provider business mailing address

400 W RIVER DRIVE
WEST BEND WI
53090
US

V. Phone/Fax

Practice location:
  • Phone: 262-338-2717
  • Fax: 262-338-9767
Mailing address:
  • Phone: 262-338-2717
  • Fax: 262-338-9767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number528123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: