Provider Demographics
NPI:1831108851
Name:SKUPNIEWITZ, LEE MARGARET (APSW MSSW)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:MARGARET
Last Name:SKUPNIEWITZ
Suffix:
Gender:F
Credentials:APSW MSSW
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:MARGARET
Other - Last Name:PEASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1040 S 70TH STREET
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3164
Mailing Address - Country:US
Mailing Address - Phone:414-476-9675
Mailing Address - Fax:414-615-0627
Practice Address - Street 1:1040 S 70TH STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-3164
Practice Address - Country:US
Practice Address - Phone:414-476-9675
Practice Address - Fax:414-615-0627
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2155121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41001900Medicaid