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Individual

MISS MARY ANN HERZOG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CPS

Contact information

Practice address
10045 W LISBON AVE, WAUWATOSA, WI 53222-2446
(414) 358-7146
(414) 358-7158
Mailing address
10045 W LISBON AVE, WAUWATOSA, WI 53222-2446
(414) 358-7146
(414) 358-7158

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
193200000X
WI
Enumeration date
09/24/2014
Last updated
09/24/2014
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