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General NPI Number Information
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NPI Number | 1679707152
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Entity Type | Organization
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Legal Business Name | NAKODA COGNITIVE BEHAVIORAL SERVICES, LLC
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 204 E CAPITOL DR SUITE 106
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City | MILWAUKEE
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State | WI
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Zip | 53212-1200
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Country | US
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Telephone | 414-332-0886
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Fax | 414-332-0886
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Provider Business Mailing Address
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Address Line | 204 EAST CAPITOL DRIVE SUITE 106
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City | MILWAUKEE
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State | WISCONSIN
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Zip | 53212
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Country | UM
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Telephone | 414-332-0886
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Fax | 414-332-0886
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MS. GERI MCFADDEN
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Credential | LCSW
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Telephone | 414-332-0886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2722
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License Number State | WI
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