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General NPI Number Information
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NPI Number | 1174329429
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Entity Type | Organization
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Legal Business Name | MASON SAFE ZONE
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 3268 N 34TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53216-3704
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Country | US
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Telephone | 414-865-5556
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Fax |
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Provider Business Mailing Address
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Address Line | 3268 N 34TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53216-3704
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Country | US
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Telephone | 414-865-5556
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MISS VICKIE BRADLEY
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Credential | OTHER
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Telephone | 414-865-5556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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