Individual
ANTONIO T BOSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SAC-IT
Contact information
Practice address
2821 N 4TH ST STE 139, MILWAUKEE, WI 53212-2362
(414) 264-4217
(414) 264-4218
Mailing address
2821 N 4TH ST STE 139, MILWAUKEE, WI 53212-2362
(414) 264-4217
(414) 264-4218
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16231-130
WI
Other
Enumeration date
01/06/2012
Last updated
01/06/2012
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