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Individual

LISSA R MYHRE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS

Contact information

Practice address
1 S MAIN ST, JANESVILLE, WI 53545-3977
(608) 757-0404
(608) 757-2319
Mailing address
1 S MAIN ST, PO BOX 8010, JANESVILLE, WI 53545-3977
(608) 757-0404
(608) 757-2319

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4254-123
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
39642700
WI
Enumeration date
03/13/2008
Last updated
03/13/2008
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