Individual
LANA CHESLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1506 S ONEIDA ST, APPLETON, WI 54915-1305
(920) 738-2490
Mailing address
1136 S ROOSEVELT ST, GREEN BAY, WI 54301-3104
(920) 321-4102
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8077-123
WI
Other
Enumeration date
04/10/2014
Last updated
04/10/2014
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