Provider Demographics
NPI:1225302243
Name:CANNON, DREW DOUGLAS (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:DOUGLAS
Last Name:CANNON
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 N 51ST STREET
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218
Mailing Address - Country:US
Mailing Address - Phone:414-527-6970
Mailing Address - Fax:414-527-6971
Practice Address - Street 1:5555 N 51ST STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218
Practice Address - Country:US
Practice Address - Phone:414-527-6970
Practice Address - Fax:414-527-6971
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7802-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical