Doctor Name: | MRS. JACQUELINE SILLS |
NPI Number: | 1679944110 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SAC-IT |
License Number: | 16689-130 |
Business Practice Address: | 1610 Miller Park Way West Milwaukee, WI - 532143604 |
Business Phone Number: | 4146723801 |
Business Fax Number: | 4146726026 |
Mailing Address: | 1610 Miller Park Way, WEST MILWAUKEE |
State: | WI |
Postal Code: | 532143604 |
Phone Number: | 4146723801 |
Fax Number: | 4146726026 |
NPI Enumeration Date: | 10/09/2015 |
NPI Last Update Date: | 10/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 16689-130 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |