Provider Demographics
NPI:1164592655
Name:DREW, POLLY ELIZABETH (LCSW, LMFT)
Entity Type:Individual
Prefix:MS
First Name:POLLY
Middle Name:ELIZABETH
Last Name:DREW
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W GLEN OAKS LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3365
Mailing Address - Country:US
Mailing Address - Phone:262-478-0888
Mailing Address - Fax:262-478-9329
Practice Address - Street 1:1001 W GLEN OAKS LN
Practice Address - Street 2:SUITE 205
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3365
Practice Address - Country:US
Practice Address - Phone:262-478-0888
Practice Address - Fax:262-478-9329
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1988-1231041C0700X
WI21-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist