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Individual

MRS. JENNIFER M CARRASCO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.A. PHD

Contact information

Practice address
2555 N DR MARTIN LUTHER KING DR, MILWAUKEE, WI 53212-2709
(414) 372-8080
(414) 267-8570
Mailing address
2555 N DR MARTIN LUTHER KING JR DR, MILWAUKEE, WI 53212-2709
(414) 372-8080
(414) 372-7425

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3124-57
WI
103TC0700X
Clinical Psychologist
3124-57
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100015903
WI
Enumeration date
06/20/2011
Last updated
07/03/2024
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