Individual
MRS. LISA A POLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED.,LPC
Contact information
Practice address
900 6TH ST N STE 104, HUDSON, WI 54016-7172
(715) 688-9178
(715) 688-4916
Mailing address
2206 90TH AVENUE, BALDWIN, WI 54002-3222
(715) 688-4913
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3794-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43743400
—
WI
Enumeration date
09/12/2008
Last updated
07/02/2009
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