Individual
MARCIA VASTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
123 N OAKLAND AVE, GREEN BAY, WI 54303-2831
(920) 770-4088
(651) 705-0026
Mailing address
PO BOX 8003, APPLETON, WI 54912-8003
(920) 996-3298
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39599500
—
WI
Enumeration date
12/06/2006
Last updated
09/25/2024
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