Individual
IDA MARY UMENTUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
141 SIEGLER ST, GREEN BAY, WI 54303-2635
(920) 497-3126
Mailing address
3122 SAVANNA WAY, GREEN BAY, WI 54311-5043
(920) 321-0387
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
888-122
WI
Other
Enumeration date
05/30/2007
Last updated
07/08/2007
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