Provider Demographics
NPI:1578001129
Name:MINOR, VANESSA (MS, LPC, CSAC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:MINOR
Suffix:
Gender:F
Credentials:MS, LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11801 W SILVER SPRING DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-3092
Mailing Address - Country:US
Mailing Address - Phone:414-367-9155
Mailing Address - Fax:
Practice Address - Street 1:11801 W SILVER SPRING DR STE 107
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-3092
Practice Address - Country:US
Practice Address - Phone:414-367-9155
Practice Address - Fax:414-600-9080
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16042-132101YA0400X
WI6104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1578001129Medicaid