Individual
SOUTHIDA XAYACHACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3900 W BROWN DEER RD, SUITE 200, BROWN DEER, WI 53209-1220
(414) 540-2170
(414) 540-2171
Mailing address
3900 W BROWN DEER RD, SUITE 200, BROWN DEER, WI 53209-1220
(414) 540-2170
(414) 540-2171
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
130138
WI
Other
Enumeration date
07/28/2016
Last updated
07/28/2016
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