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General NPI Number Information
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NPI Number | 1861521171
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Entity Type | Individual
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Provider Name | MARYANN REESE LMFT,LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10425 W NORTH AVE SUITE 314
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City | WAUWATOSA
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State | WI
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Zip | 53226-2416
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Country | US
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Telephone | 414-778-2233
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Fax |
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Provider Business Mailing Address
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Address Line | 3510 RIDGE DR
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City | HARTLAND
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State | WI
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Zip | 53029-9357
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Country | US
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Telephone | 414-778-2233
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 212-124
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License Number State | WI
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