Individual
MR. MARTIN GORDON MILLICHAP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
514 RIVERVIEW AVE, WAUKESHA, WI 53188-3631
(262) 548-7688
(262) 548-7656
Mailing address
514 RIVERVIEW AVE, WAUKESHA, WI 53188-3631
(262) 548-7688
(262) 548-7656
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2351-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39197000
—
WI
Enumeration date
12/19/2006
Last updated
12/10/2013
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