Individual
MARIAH HEWITT
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
840 LAKE AVE, STE 101, RACINE, WI 53403-1566
(262) 634-8688
(262) 634-7547
Mailing address
409 KENNEDY CT W, COLGATE, WI 53017-9749
(262) 993-4402
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2534-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40960500
—
WI
Enumeration date
06/15/2006
Last updated
07/08/2007
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