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General NPI Number Information
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NPI Number | 1831533470
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Entity Type | Organization
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Legal Business Name | LIFESTRIDERS, INC.
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Dates
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Enumeration Date | 04/25/2013
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Last Update Date | 04/25/2013
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Provider Practice Location Address
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Address Line | S11W29667 SUMMIT AVE
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City | WAUKESHA
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State | WI
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Zip | 53188-9476
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Country | US
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Telephone | 262-565-6124
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Fax |
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Provider Business Mailing Address
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Address Line | S11W29667 SUMMIT AVE
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City | WAUKESHA
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State | WI
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Zip | 53188-9476
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Country | US
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Telephone | 262-565-6124
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/ PSYCHOLOGIST
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Name | MRS. VERONICA SOSA
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Credential | MS, LPC
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Telephone | 262-309-9297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 12430-800
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License Number State | WI
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