Provider Demographics
NPI:1184411837
Name:INTERNAL PEACE PATHWAYS LLC
Entity type:Organization
Organization Name:INTERNAL PEACE PATHWAYS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATRICIA
Authorized Official - Middle Name:W
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:414-301-2852
Mailing Address - Street 1:PO BOX 13913
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-0913
Mailing Address - Country:US
Mailing Address - Phone:414-301-2852
Mailing Address - Fax:414-301-2857
Practice Address - Street 1:5800 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1516
Practice Address - Country:US
Practice Address - Phone:414-301-2852
Practice Address - Fax:414-301-2857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty