Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1316284706 |
---|---|
Provider Name | Eric Douglas Green |
First Address | Milwaukee, WI 53295-0001 |
Second Address | Milwaukee, WI 53295-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2013 |
Last Update Date | 07/01/2013 |