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NPI Code Detail

MEDICARE: REBECCA LYNN CRUM KOPPES LCSW

MEDICARE: REBECCA LYNN CRUM KOPPES LCSW
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
1171M00000XCase Manager/Care Coordinator128141121WI
21041C0700XClinical Social Worker8293-123WI

General Provider Information

NPI Number : 1811240674
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA LYNN CRUM KOPPES LCSW
Provider Business Mailing Address
First Line : 4065 N 35TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53216-1705
Country : US
Telephone Number : 414-445-9180
Fax Number :
Provider Business Practice Location Address
First Line : 4065 N 35TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53216-1705
Country : US
Telephone Number : 414-445-9180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2012
Last Update Date : 08/27/2015

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Directions to “ REBECCA LYNN CRUM KOPPES LCSW” Practice Location

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