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General NPI Number Information
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NPI Number | 1710012539
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Entity Type | Individual
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Provider Name | MARTHA JACKSON OPPENEER D.MIN.
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Gender | Female
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | W156N8327 PILGRIM RD SUITE 304
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-3776
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Country | US
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Telephone | 262-251-1112
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Fax | 262-251-1113
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Provider Business Mailing Address
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Address Line | W156N8327 PILGRIM RD SUITE 304
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-3776
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Country | US
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Telephone | 262-251-1112
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Fax | 262-251-1113
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 625-124
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License Number State | WI
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