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General NPI Number Information
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NPI Number | 1619751005
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Entity Type | Individual
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Provider Name | JOSEPH CONTEZAC
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Gender | Male
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Dates
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Enumeration Date | 08/24/2023
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 10150 W NATIONAL AVE STE 390
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City | WEST ALLIS
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State | WI
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Zip | 53227-2145
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Country | US
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Telephone | 414-545-4430
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Fax |
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Provider Business Mailing Address
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Address Line | 4175 N OAKLAND AVE UNIT 316
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City | SHOREWOOD
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State | WI
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Zip | 53211-2075
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Country | US
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Telephone | 608-556-2795
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7562-226
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License Number State | WI
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