Individual
MS. DOMINIQUE SHANTELLE PRITCHETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4536 22ND AVE, KENOSHA, WI 53140-5917
(262) 656-0044
(262) 653-2218
Mailing address
3615 15TH ST, APT. 2C, KENOSHA, WI 53144-4717
(262) 496-8897
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
128010-121
WI
1041C0700X
Clinical Social Worker
Primary
7981-123
WI
Other
Enumeration date
06/25/2012
Last updated
01/30/2013
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