Individual
DR. LA'TONYA RENAE WALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2414 N 55TH ST, MILWAUKEE, WI 53210-2743
(414) 763-1177
Mailing address
2414 N 55TH ST, MILWAUKEE, WI 53210-2743
(414) 763-1177
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
625048
WI
106H00000X
Marriage & Family Therapist
91-228
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40950400
—
WI
Enumeration date
05/09/2008
Last updated
05/09/2008
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