Provider Demographics
NPI:1821784562
Name:METCALF, LAKISHA (PEER SPECIALIST)
Entity Type:Individual
Prefix:MRS
First Name:LAKISHA
Middle Name:
Last Name:METCALF
Suffix:
Gender:F
Credentials:PEER SPECIALIST
Other - Prefix:
Other - First Name:LAKISHA
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12310 W HADLEY ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-4026
Mailing Address - Country:US
Mailing Address - Phone:414-416-9684
Mailing Address - Fax:
Practice Address - Street 1:5225 N IRONWOOD RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4909
Practice Address - Country:US
Practice Address - Phone:414-416-9684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist