Individual
MRS. FREDASHARRON SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3853 N 55TH ST, MILWAUKEE, WI 53216-2209
(414) 366-9220
Mailing address
3853 N 55TH ST, MILWAUKEE, WI 53216-2209
(414) 366-9220
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
17570-130
WI
Other
Enumeration date
01/10/2017
Last updated
01/11/2017
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