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Individual

EDWIN BACALSO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
13111 N PORT WASHINGTON RD, THIENSVILLE, WI 53097-2416
(262) 243-6127
Mailing address
5215 N IRONWOOD RD, SUITE 202 PMB 1013, GLENDALE, WI 53217-2416
(414) 367-4447

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
131474-121
WI

Other

Enumeration date
07/23/2019
Last updated
05/07/2024
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