Individual
JILL M CISAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1095 MIDWAY RD, MENASHA, WI 54952-1115
(920) 720-2300
(920) 720-3806
Mailing address
1095 MIDWAY RD, MENASHA, WI 54952-1115
(920) 720-3702
(920) 720-3806
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
966-121
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43567900
—
WI
Enumeration date
12/19/2007
Last updated
12/04/2008
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