MEDICARE: GREGORY BARDEN MSW

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	129885121	WI

General Provider Information

NPI Number	:	1184095259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY BARDEN MSW

Provider Business Mailing Address
First Line	:	138 S 78TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-1407
Country	:	US
Telephone Number	:	920-229-3786
Fax Number	:

Provider Business Practice Location Address
First Line	:	138 S 78TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-1407
Country	:	US
Telephone Number	:	920-229-3786
Fax Number	:

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

Provider Enumeration Date	:	10/14/2015
Last Update Date	:	06/19/2017

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