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General NPI Number Information
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NPI Number | 1518358506
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Entity Type | Organization
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Legal Business Name | TONI LIDDY LLC
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Dates
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Enumeration Date | 02/11/2015
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 800 E LOCUST ST
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City | MILWAUKEE
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State | WI
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Zip | 53212-2634
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Country | US
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Telephone | 414-429-6522
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Fax | 414-502-0192
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Provider Business Mailing Address
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Address Line | 2369 S 57TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53219-2215
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Country | US
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Telephone | 414-429-6522
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Fax | 414-502-0192
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | ANTONETTE MARIE LIDDY
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Credential | M.S. LPC NCC
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Telephone | 414-429-6522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 244-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 244-125
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 244-125
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License Number State | WI
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