Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 12418 | WI |
Y | 1041C0700X | Clinical Social Worker | 6995-123 | WI |
NPI | 1013017169 |
---|---|
Provider Name | Thomas G Mlodzik |
First Address | Milwaukee, WI 53211-2984 |
Second Address | Milwaukee, WI 53211-2984 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 04/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12418 | CADCIII (01) | WI |
39757800 | (05) | WI |
555-124 | LMFT (01) | WI |
6995-123 | LCSW (01) | WI |