Provider Demographics
NPI:1578732921
Name:MIDCALF, CYNTHIA ANN (SAC)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ANN
Last Name:MIDCALF
Suffix:
Gender:F
Credentials:SAC
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:ANN
Other - Last Name:LOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 FOREST GROVE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-3793
Mailing Address - Country:US
Mailing Address - Phone:262-691-2980
Mailing Address - Fax:262-691-2972
Practice Address - Street 1:325 FOREST GROVE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-3793
Practice Address - Country:US
Practice Address - Phone:262-691-2980
Practice Address - Fax:262-691-2972
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15387131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)