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General NPI Number Information
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NPI Number | 1124324090
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Entity Type | Individual
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Provider Name | MARJORIE Y MENDOZA LPC
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Gender | Female
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 1205 S 70TH ST STE 301
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City | WEST ALLIS
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State | WI
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Zip | 53214-3171
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Country | US
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Telephone | 414-485-6302
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Fax |
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Provider Business Mailing Address
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Address Line | 8321 S 100TH ST
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City | FRANKLIN
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State | WI
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Zip | 53132-2409
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Country | US
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Telephone | 414-719-0076
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Fax |
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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 | 7114-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15574-132
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License Number State | WI
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