Organization
ACACIA CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEIDRA LEE KOZLOWSKI (PRESIDENT)
(414) 871-9111
Entity
Organization
Contact information
Practice address
6040 W LISBON AVE, SUITE 102, MILWAUKEE, WI 53210-2116
(414) 871-9111
(414) 871-9121
Mailing address
6040 W LISBON AVE, SUITE 102, MILWAUKEE, WI 53210-2116
(414) 871-9111
(414) 871-9121
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
1066
WI
103T00000X
Psychologist
1066
WI
103TC0700X
Clinical Psychologist
1066
WI
103TC1900X
Counseling Psychologist
1066
WI
1041C0700X
Clinical Social Worker
Primary
1066
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42167800
—
WI
Enumeration date
07/05/2006
Last updated
09/11/2025
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