Provider Demographics
NPI:1477706505
Name:CECHVALA, NANCY L (MS)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:L
Last Name:CECHVALA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W BROADWAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4833
Mailing Address - Country:US
Mailing Address - Phone:262-547-5567
Mailing Address - Fax:
Practice Address - Street 1:101 W BROADWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4833
Practice Address - Country:US
Practice Address - Phone:262-547-5567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3126-125101YP2500X
WI156451101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1568404671Medicaid