Individual
IVY ELLEN JEAN PHELPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, CSAC
Contact information
Practice address
2814 S 108TH ST, WEST ALLIS, WI 53227-3224
(414) 885-3525
Mailing address
2814 S 108TH ST, WEST ALLIS, WI 53227-3224
(414) 885-3525
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15687-132
WI
Other
Enumeration date
07/05/2017
Last updated
07/21/2022
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