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General NPI Number Information
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NPI Number | 1205107794
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Entity Type | Individual
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Provider Name | PHILIP CHARD MS, LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/16/2012
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Last Update Date | 01/16/2012
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Provider Practice Location Address
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Address Line | 1177 QUAIL CT SUITE 101
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City | PEWAUKEE
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State | WI
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Zip | 53072-3790
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Country | US
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Telephone | 262-247-0269
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Fax |
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Provider Business Mailing Address
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Address Line | 1177 QUAIL CT SUITE 101
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City | PEWAUKEE
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State | WI
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Zip | 53072-3790
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Country | US
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Telephone | 262-247-0269
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2206-123
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License Number State | WI
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