Individual
BONNIE LEGGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW, CSAC
Contact information
Practice address
2607 N GRANDVIEW BLVD, SUITE 108, WAUKESHA, WI 53188-1686
(262) 313-8339
(262) 910-1653
Mailing address
1411 GENESEE ST, DELAFIELD, WI 53018-1431
(262) 646-4217
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15897-132
WI
104100000X
Social Worker
128772-121
WI
1041C0700X
Clinical Social Worker
Primary
8292-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306004999
—
WI
Enumeration date
03/11/2013
Last updated
09/16/2015
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