MEDICARE: MR. JOSEPH M HALAIKO

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	101YM0800X	Mental Health Counselor	3708-226	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3708-226	OTHER	WI	LPC LICENSE

General Provider Information

NPI Number	:	1740791532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH M HALAIKO

Provider Business Mailing Address
First Line	:	800 WISCONSIN AVE
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53403-1526
Country	:	US
Telephone Number	:	262-637-8888
Fax Number	:	262-637-0695

Provider Business Practice Location Address
First Line	:	2021 N 60TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-1641
Country	:	US
Telephone Number	:	414-771-2881
Fax Number	:	414-771-1674

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

Provider Enumeration Date	:	10/19/2017
Last Update Date	:	10/19/2017

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