Individual
MS. JESSICA LOVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1126 S 70TH ST STE 112-3, WEST ALLIS, WI 53214-3124
(414) 727-2789
Mailing address
2440 N 85TH ST, WAUWATOSA, WI 53226-1912
(414) 475-1656
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
128219-121
WI
Other
Enumeration date
03/31/2018
Last updated
04/03/2018
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