Organization
NEUROWAVE THERAPY GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRIAM E CORONA LPC, CSAC (OWNER)
(262) 447-8999
Entity
Organization
Contact information
Practice address
5910 39TH AVE, KENOSHA, WI 53144-2738
(262) 833-5999
(262) 357-8431
Mailing address
1920 90TH ST, STURTEVANT, WI 53177-1806
(262) 833-5999
(262) 357-8431
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649745340
—
WI
Enumeration date
08/30/2024
Last updated
04/03/2025
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