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General NPI Number Information
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NPI Number | 1215892575
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Entity Type | Individual
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Provider Name | COURTNEY DAWN SLAK APSW, MSW
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Gender | Female
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Dates
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Enumeration Date | 12/18/2025
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 7101 N GREEN BAY AVE STE 12
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City | GLENDALE
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State | WI
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Zip | 53209-2800
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Country | US
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Telephone | 414-216-3826
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Fax |
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Provider Business Mailing Address
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Address Line | N60W21630 LEGACY TRL
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-7007
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Country | US
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Telephone | 414-216-3826
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 3001028238
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License Number State | WI
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