Individual
BARBARA JUNE PETTIBONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2800 LASALLE ST, RACINE, WI 53402-4140
(262) 221-2057
Mailing address
2800 LASALLE ST, RACINE, WI 53402-4140
(262) 221-2057
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
00001879
CO
Other
Enumeration date
11/17/2020
Last updated
11/17/2020
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