Provider Demographics
NPI:1528602992
Name:OMONDI, DEBORAH E (MS)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:E
Last Name:OMONDI
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 1:1720 W FLORIST AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3862
Mailing Address - Country:US
Mailing Address - Phone:414-247-0801
Mailing Address - Fax:414-247-0816
Practice Address - Street 1:1720 W FLORIST AVE STE 125
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-3862
Practice Address - Country:US
Practice Address - Phone:414-247-0801
Practice Address - Fax:414-247-0816
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8362101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI8362OtherLICENSE