Organization
PROFESSIONAL SERVICES GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERRIE E BOECKMAN LCSW (CLINIC THERAPIST)
(262) 652-2406
Entity
Organization
Contact information
Practice address
2108 63RD ST, KENOSHA, WI 53143-4454
(262) 652-2406
Mailing address
2108 63RD ST, KENOSHA, WI 53143-4454
(262) 652-2406
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
8047-123
WI
Other
Enumeration date
09/24/2013
Last updated
09/24/2013
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