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General NPI Number Information
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NPI Number | 1497401095
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Entity Type | Organization
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Legal Business Name | TRILOGY HEALTH GROUP LLC
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Dates
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Enumeration Date | 02/23/2022
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Last Update Date | 05/23/2022
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Provider Practice Location Address
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Address Line | 2717 N GRANDVIEW BLVD STE 103
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City | WAUKESHA
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State | WI
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Zip | 53188-1672
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Country | US
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Telephone | 262-565-6202
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Fax | 414-435-3152
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Provider Business Mailing Address
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Address Line | 2717 N GRANDVIEW BLVD STE 103
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City | WAUKESHA
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State | WI
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Zip | 53188-1672
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Country | US
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Telephone | 262-565-6202
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Fax | 414-435-3152
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Authorized Official
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Title or Position | CO-OWNER
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Name | LISA CWIKLA
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Credential | APNP
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Telephone | 414-828-3244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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