Individual
MS. CAROLYN R SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
741 N GRAND AVE, SUITE 302, WAUKESHA, WI 53186-4820
(262) 542-3255
Mailing address
S57W25446 LOIS LN, WAUKESHA, WI 53189-9605
(262) 542-4842
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
702-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39225600
—
WI
Enumeration date
09/15/2006
Last updated
07/08/2007
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