Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 7032-26 | WI |
NPI | 1528733136 |
---|---|
Provider Name | Mrs. Karenna Joelle Zills |
First Address | West Allis, WI 53214-5069 |
Second Address | Milwaukee, WI 53226-3559 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2021 |
Last Update Date | 16/08/2021 |