Individual
SOPHIA FIORENZA FORMOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
2333 NORTHWESTERN AVE, RACINE, WI 53404-2520
(262) 638-2000
Mailing address
6233 39TH AVE, KENOSHA, WI 53142-7015
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
8868
WI
Other
Enumeration date
02/12/2026
Last updated
02/12/2026
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