Individual
COREY BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8731 N 64TH ST, BROWN DEER, WI 53223-2823
(414) 367-7176
Mailing address
8731 N 64TH ST, BROWN DEER, WI 53223-2823
(414) 367-7176
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/11/2023
Last updated
04/11/2023
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