MEDICARE: ADVENTURES IN PLAY, 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	251S00000X	Community/Behavioral Health Agency	8463-123	WI

General Provider Information

NPI Number	:	1528413671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVENTURES IN PLAY, LLC

Provider Business Mailing Address
First Line	:	2118 E KENILWORTH PL
Second Line	:	LOWR
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-1327
Country	:	US
Telephone Number	:	847-722-6704
Fax Number	:	414-306-7171

Provider Business Practice Location Address
First Line	:	2118 E KENILWORTH PL
Second Line	:	LOWR
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-1327
Country	:	US
Telephone Number	:	847-722-6704
Fax Number	:	414-306-7171

Authorized Official
Title or Position	:	THERAPIST
Name	:	STEPHANIE L MILLER
Credential	:	M.S., L.C.S.W.
Telephone Number	:	847-722-6704

Provider Enumeration Date	:	04/26/2016
Last Update Date	:	04/26/2016

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Directions to “ADVENTURES IN PLAY, LLC ” Practice Location

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