Provider Demographics
NPI:1760677439
Name:VALLEJO, CECILIA (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:
Last Name:VALLEJO
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 S 16TH ST
Mailing Address - Street 2:SUITE 219
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-2203
Mailing Address - Country:US
Mailing Address - Phone:414-672-3145
Mailing Address - Fax:414-383-5597
Practice Address - Street 1:1032 S 16TH ST
Practice Address - Street 2:SUITE 219
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-2203
Practice Address - Country:US
Practice Address - Phone:414-672-3145
Practice Address - Fax:414-383-5597
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI75106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39182000Medicaid