Individual
DONALD WEATHERALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2821 N 4TH ST, MILWAUKEE, WI 53212-2362
(414) 372-9542
Mailing address
2821 N 4TH ST, MILWAUKEE, WI 53212-2362
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
10917
WI
103G00000X
Clinical Neuropsychologist
10917
WI
Other
Enumeration date
03/10/2016
Last updated
03/10/2016
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