Basic Information
| Provider Information | |||||||||
| NPI: | 1710314000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | ROXXI | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | LCSW, APSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7113 TAMARACK CT | ||||||||
| Address2: | |||||||||
| City: | MEQUON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625738465 | ||||||||
| FaxNumber: | 2175288962 | ||||||||
| Practice Location | |||||||||
| Address1: | 7113 TAMARACK CT | ||||||||
| Address2: | |||||||||
| City: | MEQUON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625738465 | ||||||||
| FaxNumber: | 2175288962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2013 | ||||||||
| LastUpdateDate: | 02/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 149.015543 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.