Provider Demographics
NPI:1922021047
Name:POWERS, ROMONA (MSW, LCSW, LMFT)
Entity Type:Individual
Prefix:
First Name:ROMONA
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:MSW, LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 W MORELAND BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2400
Mailing Address - Country:US
Mailing Address - Phone:262-542-0123
Mailing Address - Fax:262-542-1199
Practice Address - Street 1:707 W MORELAND BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-2400
Practice Address - Country:US
Practice Address - Phone:262-542-0123
Practice Address - Fax:262-542-1199
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1368-123101YM0800X
WI403-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39574600Medicaid