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General NPI Number Information
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NPI Number | 1053674085
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Entity Type | Individual
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Provider Name | LEANN VICE-RESHEL B.A.
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Gender | Female
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Dates
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Enumeration Date | 06/25/2012
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 5433 W FOND DU LAC AVE
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City | MILWAUKEE
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State | WI
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Zip | 53216-1382
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Country | US
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Telephone | 414-228-4800
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Fax | 414-277-8939
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Provider Business Mailing Address
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Address Line | 9000 W WISCONSIN AVE # MS 958
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City | MILWAUKEE
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State | WI
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Zip | 53226-4874
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Country | US
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Telephone | 414-266-7615
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Fax | 414-266-6238
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6176
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License Number State | WI
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