Individual
ANTONIA SALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS,SAC,DPI TEACHER
Contact information
Practice address
6040 W LISBON AVE, MILWAUKEE, WI 53210-2116
(414) 364-0406
(414) 442-6387
Mailing address
PO BOX 16725, 3762 NORTH 38TH STREET, MILWAUKEE, WI 53216-0725
(414) 364-0406
(414) 442-6387
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15375-130
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15375-130
SUBSTANCE ABUSE COUNSELOR
WI
Enumeration date
03/02/2007
Last updated
07/08/2007
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