Organization
CHANGE 4 CHILDREN SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. THERESA T BOSWELL LCSW (EXECUTIVE DIRECTOR)
(414) 289-0937
Entity
Organization
Contact information
Practice address
2266 N PROSPECT AVE, 605, MILWAUKEE, WI 53202-6319
(414) 289-0937
(414) 289-0938
Mailing address
2266 N PROSPECT AVE, 605, MILWAUKEE, WI 53202-6319
(414) 289-0937
(414) 289-0938
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42239100
—
WI
Enumeration date
09/09/2008
Last updated
09/09/2008
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