Individual
LATRICE BUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4400 W MELVINA ST, MILWAUKEE, WI 53216-2435
(414) 334-1455
Mailing address
4400 W. MELVINA AVE, MILWAUKEE, WI 53216
(414) 334-1455
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12098
WI
104100000X
Social Worker
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39748500
—
WI
Enumeration date
02/02/2009
Last updated
02/02/2009
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