Provider Demographics
NPI:1134469711
Name:MCCOLLUM, DOROTHY REE (MSW, APSW)
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:REE
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:MSW, APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4039 N 19TH PL
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-6806
Mailing Address - Country:US
Mailing Address - Phone:414-384-2000
Mailing Address - Fax:414-902-5468
Practice Address - Street 1:4039 N 19TH PL
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-6806
Practice Address - Country:US
Practice Address - Phone:414-384-2000
Practice Address - Fax:414-902-5468
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI128307-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1041C0700OtherSOCIAL WORKER CLINICAL.