Individual
MICHELLE PIVONKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APSW
Contact information
Practice address
926 WILLARD DR STE 136, GREEN BAY, WI 54304
(920) 461-5820
Mailing address
4631 CINDY CT, NEW FRANKEN, WI 54229-9430
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
131063-121
WI
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
05/07/2018
Last updated
06/11/2018
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