Individual
LISA JAMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
418 E WISCONSIN AVE, OCONOMOWOC, WI 53066-3040
(414) 429-6403
Mailing address
1085 REVERE DR, OCONOMOWOC, WI 53066-4422
(414) 429-6403
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6555-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
463263406
1477543981
WI
Enumeration date
01/29/2019
Last updated
01/29/2019
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