Individual
MR. ROGER PATRICK NORTHWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS LCSW
Contact information
Practice address
13105 W BLUEMOUND RD, SUITE 100, BROOKFIELD, WI 53005-8046
(262) 641-9790
(262) 641-9791
Mailing address
13105 W BLUEMOUND RD, SUITE 100, BROOKFIELD, WI 53005-8046
(262) 641-9790
(262) 641-9791
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
477125
WI
1041C0700X
Clinical Social Worker
2661123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39197200
—
WI
Enumeration date
03/01/2007
Last updated
09/11/2025
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