MEDICARE: VICKY L PADWAY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2664-123	WI

General Provider Information

NPI Number	:	1063726214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKY L PADWAY LCSW

Provider Business Mailing Address
First Line	:	633 W WISCONSIN AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53203-1918
Country	:	US
Telephone Number	:	414-352-0305
Fax Number	:	414-352-0305

Provider Business Practice Location Address
First Line	:	4200 W GOOD HOPE RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-2250
Country	:	US
Telephone Number	:	414-351-5770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	10/08/2013

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