Provider Demographics
NPI:1275729915
Name:DRAKE, MARGARET (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N. SUNNYSLOPE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005
Mailing Address - Country:US
Mailing Address - Phone:262-432-5660
Mailing Address - Fax:262-432-5666
Practice Address - Street 1:150 N. SUNNYSLOPE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005
Practice Address - Country:US
Practice Address - Phone:262-432-5660
Practice Address - Fax:262-432-5666
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3572-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40974500Medicaid