Organization
EMPOWER HER THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE ELMER CPCS (CREDENTIALING MANAGER)
(608) 352-8323
Entity
Organization
Contact information
Practice address
W4795 DEER RUN DR, BLACK CREEK, WI 54106-8175
(920) 205-6158
Mailing address
W4795 DEER RUN DR, BLACK CREEK, WI 54106-8175
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
03/05/2024
Last updated
03/05/2024
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