Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 4590-125 | WI |
NPI | 1003053497 |
---|---|
Provider Name | Mrs. Kimberly A Mccormick |
First Address | Milwaukee, WI 53233-1507 |
Second Address | Milwaukee, WI 53233-1507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2009 |
Last Update Date | 06/06/2011 |