Individual
MARY M DETERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW LCSW
Contact information
Practice address
5757 W OKLAHOMA AVE, SUITE 203, MILWAUKEE, WI 53219-4303
(414) 431-6400
(414) 431-6401
Mailing address
5757 W OKLAHOMA AVE, STE 203, MILWAUKEE, WI 53219-4303
(414) 431-6400
(414) 431-6401
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1174-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39737200
—
WI
Enumeration date
03/10/2007
Last updated
01/29/2018
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