Provider Demographics
NPI:1184079022
Name:BROSE, HEATHER MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:BROSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:ROWLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5745 CAMBRIDGE LN
Mailing Address - Street 2:UNIT 1
Mailing Address - City:MT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-2837
Mailing Address - Country:US
Mailing Address - Phone:262-497-5526
Mailing Address - Fax:
Practice Address - Street 1:7635 W OKLAHOMA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53219-3600
Practice Address - Country:US
Practice Address - Phone:414-301-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8513-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical