Individual
ELIZABETH POTTHAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4383 N 27TH ST, MILWAUKEE, WI 53216-1809
(414) 871-8883
(414) 871-8950
Mailing address
2023 N 86TH ST LOWR, WAUWATOSA, WI 53226-2744
(262) 960-0798
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
13400-132
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15119-135
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39399900
—
WI
Enumeration date
02/13/2007
Last updated
07/09/2007
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