Individual
DANNIE STALLWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC-IT
Contact information
Practice address
4025 N 92ND ST, WAUWATOSA, WI 53222-1613
(414) 435-1115
Mailing address
4025 N 92ND ST, WAUWATOSA, WI 53222-1613
(414) 435-1115
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
8079
WI
Other
Enumeration date
09/16/2024
Last updated
09/16/2024
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