Individual
ALICE FAYE PORTIS-PATTERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
6939 MARINER DR, SUITE C, RACINE, WI 53406-3938
(262) 886-8702
(262) 886-8713
Mailing address
3416 DAISY LN, RACINE, WI 53405-4606
(262) 554-8743
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
947-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
222157
VALUE OPTION
WI
05
—
39228200
—
WI
Enumeration date
01/19/2007
Last updated
07/08/2007
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