Individual
LIZA JAYNE DRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
W4051 COUNTY ROAD NN, ELKHORN, WI 53121-4338
(262) 741-3200
(262) 741-3315
Mailing address
7432 W BLUEMOUND RD, WAUWATOSA, WI 53213-3655
(414) 807-3477
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7220123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40914700
—
WI
01
—
P00264098
RAILROAD MEDICARE
—
Enumeration date
07/15/2006
Last updated
03/02/2010
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