Individual
JACK A PLATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW,LMFT
Contact information
Practice address
4810 NORTHWESTERN AVE, RACINE, WI 53406-1504
(262) 637-9984
(262) 637-9995
Mailing address
4810 NORTHWESTERN AVE, RACINE, WI 53406-1504
(262) 637-9984
(262) 637-9995
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
698-123
WI
106H00000X
Marriage & Family Therapist
209-124
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39534500
—
WI
Enumeration date
02/13/2007
Last updated
09/23/2010
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