Individual
CARLY WALLNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
121 W MAIN ST, PORT WASHINGTON, WI 53074-1813
(262) 238-8130
Mailing address
121 W MAIN ST, PORT WASHINGTON, WI 53074-1813
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
8355-125
WI
101YP2500X
Professional Counselor
8355-125
WI
Other
Enumeration date
06/07/2022
Last updated
07/10/2024
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