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General NPI Number Information
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NPI Number | 1326492349
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Entity Type | Organization
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Legal Business Name | SNJ COGNITIVE HEALTH, LLC
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Dates
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Enumeration Date | 04/15/2016
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Last Update Date | 04/15/2016
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Provider Practice Location Address
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Address Line | W241N5972 GOLDENCREST CT
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City | SUSSEX
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State | WI
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Zip | 53089-3687
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Country | US
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Telephone | 414-406-5598
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Fax |
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Provider Business Mailing Address
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Address Line | W241N5972 GOLDENCREST CT
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City | SUSSEX
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State | WI
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Zip | 53089-3687
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Country | US
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Telephone | 414-406-5598
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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 | SARA O'HARA
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Credential | LCSW
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Telephone | 414-406-5598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 8006-123
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License Number State | WI
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