Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 1627125 | WI |
N | 101YS0200X | School Counselor | L635000118158 | WI |
NPI | 1154597771 |
---|---|
Provider Name | Ms. Phyllis Ann Lardinois |
First Address | Wauwatosa, WI 53226-3359 |
Second Address | Milwaukee, WI 53208-3252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2008 |
Last Update Date | 04/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26-1704319 | INTERNAL REVENUE SERVICE (01) | WI |