Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 634-26 | WI |
NPI | 1669835542 |
---|---|
Provider Name | Sherry Thiemer |
First Address | Milwaukee, WI 53204-2141 |
Second Address | Milwaukee, WI 53204-2141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2016 |
Last Update Date | 30/03/2016 |