Organization
ST. CHARLES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHERINE ANNA DIBB 15361131 (SUBSTANCE ABUSE COUNSELOR)
(414) 358-5381
Entity
Organization
Contact information
Practice address
4757 N 76TH ST, MILWAUKEE, WI 53218-4732
(414) 358-4145
(414) 358-5002
Mailing address
4757 N 76TH ST, MILWAUKEE, WI 53218-4732
(414) 358-4145
(414) 358-5002
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
15361131
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3918300
—
WI
Enumeration date
04/29/2008
Last updated
04/29/2008
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