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TRANSFORMATIONSERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. INGRID DIANN HICKS PH.D (CLINICAL & EXECUTIVE DIRECTOR)
(414) 933-7083
Entity
Organization

Contact information

Practice address
835 N 23RD ST, 212, MILWAUKEE, WI 53233-3300
(414) 933-7083
(414) 933-7883
Mailing address
835 N 23RD ST, 212, MILWAUKEE, WI 53233-3300
(414) 933-7083
(414) 933-7883

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15226-130
WI
103TC0700X
Clinical Psychologist
1198
WI

Other

Enumeration date
08/17/2009
Last updated
08/17/2009
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