Provider Demographics
NPI:1255835963
Name:HERZIGER, CALLA (SAC-IT)
Entity Type:Individual
Prefix:
First Name:CALLA
Middle Name:
Last Name:HERZIGER
Suffix:
Gender:F
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 S INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-4025
Mailing Address - Country:US
Mailing Address - Phone:262-297-2500
Mailing Address - Fax:
Practice Address - Street 1:2727 W CLEVELAND AVE STE 204
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-2956
Practice Address - Country:US
Practice Address - Phone:414-269-8356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)