Organization
MARY DETERMAN MSW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARYELLEN ROZGA (BUSINESS MANAGER)
(414) 431-6400
Entity
Organization
Contact information
Practice address
5757 W OKLAHOMA AVE, SUITE 203, MILWAUKEE, WI 53219-4303
(414) 431-6400
(414) 431-6401
Mailing address
5757 W OKLAHOMA AVE, SUITE 203, MILWAUKEE, WI 53219-4303
(414) 431-6400
(414) 431-6401
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2357
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42235600
—
WI
Enumeration date
03/10/2007
Last updated
08/22/2020
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