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Individual

MS. KENNA RUTH POMEROY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CAPSW, CADC-D

Contact information

Practice address
210 W CAPITOL DR, MILWAUKEE, WI 53212-1123
(414) 727-6320
(414) 727-6321
Mailing address
3166A S 16TH ST, MILWAUKEE, WI 53215-4525
(414) 727-6320
(414) 727-6321

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
14804-13L
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
14804-13L
CADC-D
WI
05
39176500
WI
Enumeration date
04/25/2007
Last updated
07/09/2007
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