Individual
MISS SUSAN BEVERLY COLLYARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
4929 W FOND DU LAC AVE, MILWAUKEE, WI 53216-2324
(414) 871-6122
(414) 871-2552
Mailing address
PO BOX 18453, MILWAUKEE, WI 53218-0453
(262) 617-1258
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
100-226
WI
Other
Enumeration date
12/19/2006
Last updated
12/17/2013
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