Provider Demographics
NPI:1114063823
Name:MASON, MONICA CECILIA (MS LPC)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:CECILIA
Last Name:MASON
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4036 W LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8494
Mailing Address - Country:US
Mailing Address - Phone:414-423-5968
Mailing Address - Fax:
Practice Address - Street 1:6233 DURAND AVE
Practice Address - Street 2:SUITE F
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4961
Practice Address - Country:US
Practice Address - Phone:262-554-8165
Practice Address - Fax:262-554-8152
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1799-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10Other25