Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 3042-226 | WI |
NPI | 1003354002 |
---|---|
Provider Name | Sophia Elizabeth Prater |
First Address | Milwaukee, WI 53216-1346 |
Second Address | Milwaukee, WI 53216-1346 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2017 |
Last Update Date | 09/02/2017 |