Individual
SAMKHANN MAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
300 FEMRITE DR, MONONA, WI 53716-3716
(608) 755-5260
Mailing address
300 FEMRITE DR, MONONA, WI 53716-3716
(608) 755-5260
(608) 755-5267
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
3049
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
1928
WI
104100000X
Social Worker
Primary
3049
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750307815
—
WI
Enumeration date
07/14/2006
Last updated
11/02/2021
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