Organization
TRANSFORMATIONSERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
INGRID DIANN HICKS PH.D (CLINICLA DIRECTOR)
(414) 933-7083
Entity
Organization
Contact information
Practice address
835 N 23RD ST, 212, MILWAUKEE, WI 53233-3300
(414) 933-7083
Mailing address
835 N 23RD ST, 212, MILWAUKEE, WI 53233-3300
(414) 933-7083
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
1198
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42252421
—
WI
Enumeration date
07/14/2008
Last updated
07/14/2008
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