MEDICARE: THE GUIDANCE FOR SUCCESS PROGRAM

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1245160530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GUIDANCE FOR SUCCESS PROGRAM

Provider Business Mailing Address
First Line	:	3340 S 22ND ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-4806
Country	:	US
Telephone Number	:	414-253-9689
Fax Number	:

Provider Business Practice Location Address
First Line	:	3340 S 22ND ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-4806
Country	:	US
Telephone Number	:	414-253-9689
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	TEDRICKA KEARRA FRAZIER
Credential	:	BSW
Telephone Number	:	414-484-1219

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

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