Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 149017843 | IL |
Y | 1041C0700X | Clinical Social Worker | 8447123 | WI |
NPI | 1003162983 |
---|---|
Provider Name | Mr. Travis Jay Trott |
First Address | Milwaukee, WI 53202-1933 |
Second Address | Milwaukee, WI 53202-1933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2012 |
Last Update Date | 01/04/2017 |