Provider Demographics
NPI:1457022808
Name:ESSENTIALLY EMPOWERED, INC
Entity Type:Organization
Organization Name:ESSENTIALLY EMPOWERED, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAKEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:CHW, CLS, DOUA
Authorized Official - Phone:262-505-7811
Mailing Address - Street 1:2715 W CARMEN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-4228
Mailing Address - Country:US
Mailing Address - Phone:262-505-7811
Mailing Address - Fax:
Practice Address - Street 1:2715 W CARMEN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-4228
Practice Address - Country:US
Practice Address - Phone:262-505-7811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-24
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty