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General NPI Number Information
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NPI Number | 1861776866
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Entity Type | Individual
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Provider Name | MR. ROGER W PLATH
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Gender | Male
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 3200 W HIGHLAND BLVD
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City | MILWAUKEE
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State | WI
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Zip | 53208-3252
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Country | US
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Telephone | 414-345-4940
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Fax |
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Provider Business Mailing Address
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Address Line | 13775 W PARK AVE
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City | NEW BERLIN
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State | WI
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Zip | 53151-2561
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1163-226
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 240 228
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License Number State | WI
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