Provider Demographics
NPI:1558593129
Name:TRANSFORMATIONSERVICES
Entity Type:Organization
Organization Name:TRANSFORMATIONSERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL & EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:DIANN
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:414-933-7083
Mailing Address - Street 1:835 N 23RD ST
Mailing Address - Street 2:212
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-3300
Mailing Address - Country:US
Mailing Address - Phone:414-933-7083
Mailing Address - Fax:414-933-7883
Practice Address - Street 1:835 N 23RD ST
Practice Address - Street 2:212
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-3300
Practice Address - Country:US
Practice Address - Phone:414-933-7083
Practice Address - Fax:414-933-7883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15226-130101YA0400X
WI1198103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty