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General NPI Number Information
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NPI Number | 1205660206
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Entity Type | Organization
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Legal Business Name | NEUROWAVE THERAPY GROUP LLC
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Dates
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Enumeration Date | 08/30/2024
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 5910 39TH AVE
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City | KENOSHA
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State | WI
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Zip | 53144-2738
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Country | US
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Telephone | 262-833-5999
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Fax | 262-357-8431
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Provider Business Mailing Address
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Address Line | 1920 90TH ST
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City | STURTEVANT
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State | WI
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Zip | 53177-1806
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Country | US
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Telephone | 262-833-5999
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Fax | 262-357-8431
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Authorized Official
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Title or Position | OWNER
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Name | MIRIAM E CORONA
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Credential | LPC, CSAC
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Telephone | 262-447-8999
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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 |
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License Number State |
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