Basic Information
| Provider Information | |||||||||
| NPI: | 1740356740 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCINNIS | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 721 AMERICAN AVE | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2629282396 | ||||||||
| FaxNumber: | 2625441213 | ||||||||
| Practice Location | |||||||||
| Address1: | 721 AMERICAN AVE | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2629282396 | ||||||||
| FaxNumber: | 2625441213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 11/16/2007 | ||||||||
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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 | 104100000X | 7222123 | WI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.