Organization
PATHWAY ECLINIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY LEE CORNELLA- CARLSON MD (PSYCHIATRIST)
(414) 727-4455
Entity
Organization
Contact information
Practice address
2300 N MAYFAIR RD, SUITE 425, WAUWATOSA, WI 53226-1505
(414) 727-4455
(414) 727-4690
Mailing address
2300 N MAYFAIR RD, SUITE 425, WAUWATOSA, WI 53226-1505
(414) 727-4455
(414) 727-4690
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2605
WI
Other
Enumeration date
10/14/2008
Last updated
10/16/2008
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