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Individual

TANNER DAKOTA SIMPSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
3505 N 124TH ST, BROOKFIELD, WI 53005
(414) 431-4444
Mailing address
3505 N 124TH ST, BROOKFIELD, WI 53005-2489

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
WI
101YP2500X
Professional Counselor
Primary
12496-125
WI
171M00000X
Case Manager/Care Coordinator

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100279284
WI
Enumeration date
08/26/2019
Last updated
04/15/2026
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