Individual
COLLEEN MANGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSAC
Contact information
Practice address
1225 W HISTORIC MITCHELL ST STE 223, MILWAUKEE, WI 53204-3383
(414) 383-4455
(414) 383-6759
Mailing address
1225 W HISTORIC MITCHELL ST STE 223, MILWAUKEE, WI 53204-3383
(414) 383-4455
(414) 383-6759
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
905
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39381200
—
WI
Enumeration date
12/05/2006
Last updated
06/18/2008
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