Provider Demographics
NPI:1417417759
Name:MOUA, NKAUJ YI (LCSW)
Entity Type:Individual
Prefix:
First Name:NKAUJ
Middle Name:YI
Last Name:MOUA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9345 W CLOVERNOOK ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-5210
Mailing Address - Country:US
Mailing Address - Phone:414-587-7137
Mailing Address - Fax:
Practice Address - Street 1:9345 W CLOVERNOOK ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-5210
Practice Address - Country:US
Practice Address - Phone:414-587-7137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129938121104100000X
WI9720-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker