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General NPI Number Information
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NPI Number | 1215332028
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Entity Type | Organization
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Legal Business Name | CANDACE BUCKLEY
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | W228S2323 ORIOLE DR
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City | WAUKESHA
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State | WI
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Zip | 53186-6371
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Country | US
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Telephone | 262-501-0770
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Fax |
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Provider Business Mailing Address
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Address Line | W228S2323 ORIOLE DR
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City | WAUKESHA
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State | WI
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Zip | 53186-6371
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Country | US
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Telephone | 262-501-0770
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MRS. CANDACE LYNN BUCKLEY
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Credential | LCSW
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Telephone | 262-501-0770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 7921
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License Number State | WI
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