MEDICARE: ANNA M BANWELL LPC

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	101YP2500X	Professional Counselor	7449-125	WI

General Provider Information

NPI Number	:	1508475963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA M BANWELL LPC

Provider Business Mailing Address
First Line	:	710 W HISTORIC MITCHELL ST APT 703
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-3559
Country	:	US
Telephone Number	:	414-522-5431
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 W HISTORIC MITCHELL ST APT 703
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-3559
Country	:	US
Telephone Number	:	414-522-5431
Fax Number	:

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

Provider Enumeration Date	:	07/30/2020
Last Update Date	:	06/05/2026

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