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General NPI Number Information
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NPI Number | 1306446430
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Entity Type | Individual
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Provider Name | CALEY DELORIS MAMEROW LPC
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Gender | Female
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 04/06/2024
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Provider Practice Location Address
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Address Line | 1230 CORPORATE CENTER DR STE 100
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City | OCONOMOWOC
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State | WI
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Zip | 53066-4883
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Country | US
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Telephone | 262-789-1191
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Fax |
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Provider Business Mailing Address
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Address Line | 1230 CORPORATE CENTER DR STE 100
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City | OCONOMOWOC
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State | WI
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Zip | 53066-4883
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Country | US
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Telephone | 262-370-1540
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10051-125
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License Number State | WI
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