Individual
AUDREY LYN MASSANISSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1219 N CASS ST, MILWAUKEE, WI 53202-2770
(414) 291-9487
Mailing address
3659 E UNDERWOOD AVE, CUDAHY, WI 53110-1932
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
7502-226
WI
Other
Enumeration date
07/24/2023
Last updated
04/15/2025
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