MEDICARE: NORTH STAR CONSULTATION LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9051-123	OTHER	WI	LICENSE

General Provider Information

NPI Number	:	1083334429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH STAR CONSULTATION LLC

Provider Business Mailing Address
First Line	:	3900 W BROWN DEER RD STE A228
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-1220
Country	:	US
Telephone Number	:	260-403-7768
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 W BROWN DEER RD STE A228
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-1220
Country	:	US
Telephone Number	:	260-403-7768
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SARA KELLY
Credential	:	MSW
Telephone Number	:	414-751-0033

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	11/11/2022

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Directions to “NORTH STAR CONSULTATION LLC ” Practice Location

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