Provider Demographics
NPI:1720364045
Name:KREATIVE CONNEXIONS THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:KREATIVE CONNEXIONS THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYSSA
Authorized Official - Middle Name:K
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:414-313-5213
Mailing Address - Street 1:PO BOX 340663
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53234-0663
Mailing Address - Country:US
Mailing Address - Phone:414-313-5213
Mailing Address - Fax:414-755-0633
Practice Address - Street 1:3111 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-1127
Practice Address - Country:US
Practice Address - Phone:414-313-5213
Practice Address - Fax:414-755-0633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation