Individual
SHYRIDA DANESS LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1730 W NORTH AVE, MILWAUKEE, WI 53205-1254
(414) 906-2714
Mailing address
9381 N 49TH ST APT 102, MILWAUKEE, WI 53223-6429
(414) 499-4220
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
19075-130
WI
Other
Enumeration date
03/07/2020
Last updated
03/07/2020
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