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General NPI Number Information
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NPI Number | 1740157080
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Entity Type | Organization
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Legal Business Name | LEGACIES FAMILY DEVELOPMENT
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 3044 S 92ND ST
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City | WEST ALLIS
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State | WI
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Zip | 53227-3678
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Country | US
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Telephone | 262-693-6021
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Fax |
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Provider Business Mailing Address
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Address Line | 3044 S 92ND ST
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City | WEST ALLIS
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State | WI
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Zip | 53227-3678
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Country | US
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Telephone | 262-693-6021
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAZZMIN DIXON
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Credential |
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Telephone | 262-693-6021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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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 |
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License Number State |
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