Provider Demographics
NPI:1174006548
Name:WARD, DEBORAH A
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 SEYMOUR ST APT B
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:WI
Mailing Address - Zip Code:53585-9642
Mailing Address - Country:US
Mailing Address - Phone:262-724-8016
Mailing Address - Fax:
Practice Address - Street 1:93 W. GENEVA ST.
Practice Address - Street 2:
Practice Address - City:WILLIAMS BAY
Practice Address - State:WI
Practice Address - Zip Code:53191-9518
Practice Address - Country:US
Practice Address - Phone:262-607-6390
Practice Address - Fax:262-607-6387
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131159-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical