Provider Demographics
NPI:1710314000
Name:DAVIS, ROXXI M (LCSW, APSW)
Entity Type:Individual
Prefix:DR
First Name:ROXXI
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW, APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7113 TAMARACK CT
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092
Mailing Address - Country:US
Mailing Address - Phone:262-573-8465
Mailing Address - Fax:217-528-8962
Practice Address - Street 1:7113 TAMARACK CT
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092
Practice Address - Country:US
Practice Address - Phone:262-573-8465
Practice Address - Fax:217-528-8962
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0155431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical