Individual
DORNICHO SHANTA PULLIAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
6815 W CAPITOL DR STE 304, MILWAUKEE, WI 53216-2056
(414) 909-1079
Mailing address
8443 N 101ST CT, MILWAUKEE, WI 53224-2430
(815) 519-5256
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
130575-121
WI
Other
Enumeration date
03/20/2023
Last updated
03/20/2023
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