Provider Demographics
NPI:1346382157
Name:BARCZAK, BONNIE JEAN (MT-BC, WMTR)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:JEAN
Last Name:BARCZAK
Suffix:
Gender:F
Credentials:MT-BC, WMTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8028 W VAN BECK AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-2231
Mailing Address - Country:US
Mailing Address - Phone:414-327-5909
Mailing Address - Fax:
Practice Address - Street 1:1584 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-6501
Practice Address - Country:US
Practice Address - Phone:414-276-5760
Practice Address - Fax:414-276-6076
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34-038225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist