Provider Demographics
NPI:1922782028
Name:TREADWELL, LAKETA (CBRF,)
Entity Type:Individual
Prefix:
First Name:LAKETA
Middle Name:
Last Name:TREADWELL
Suffix:
Gender:F
Credentials:CBRF,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 W DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3619
Mailing Address - Country:US
Mailing Address - Phone:414-841-6453
Mailing Address - Fax:
Practice Address - Street 1:3617 W DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-3619
Practice Address - Country:US
Practice Address - Phone:414-841-6453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No251S00000XAgenciesCommunity/Behavioral Health
No174200000XOther Service ProvidersMeals
No253Z00000XAgenciesIn Home Supportive Care