=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568057701
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BENJAMIN WADE NEUMAN MSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2021
-----------------------------------------------------
Last Update Date | 11/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9000 W WISCONSIN AVE STE 240
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53226-4874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-337-3400
-----------------------------------------------------
Fax | 414-337-3409
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1110 S UNIVERSITY AVE APT 15
-----------------------------------------------------
City | BEAVER DAM
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53916-3130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-331-0498
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------