Organization
MINDFUL M.O.M. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUSTIANA JACKSON (OWNER, DIRECTOR OF PROGRAMMING)
(414) 793-7934
Entity
Organization
Contact information
Practice address
4555 N 65TH ST, MILWAUKEE, WI 53218-5508
(414) 793-7934
Mailing address
4555 N 65TH ST, MILWAUKEE, WI 53218-5508
(414) 793-7934
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
06/26/2020
Last updated
06/26/2020
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