Doctor Name: | MR. ROGER PATRICK NORTHWAY |
NPI Number: | 1053449173 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MS LCSW |
License Number: | 477125 |
Business Practice Address: | 13105 W Bluemound Rd Suite 100 Brookfield, WI - 530058046 |
Business Phone Number: | 2626419790 |
Business Fax Number: | 2626419791 |
Mailing Address: | 13105 W Bluemound Rd, Suite 100 BROOKFIELD |
State: | WI |
Postal Code: | 530058046 |
Phone Number: | 2626419790 |
Fax Number: | 2626419791 |
NPI Enumeration Date: | 03/01/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 477125 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |