Provider Demographics
NPI:1184929192
Name:UNDERHILL, MARGARET NMI (CSAC)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:NMI
Last Name:UNDERHILL
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 N MILWAUKEE ST
Mailing Address - Street 2:UNIT #313
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3208
Mailing Address - Country:US
Mailing Address - Phone:414-507-8593
Mailing Address - Fax:
Practice Address - Street 1:1108 N MILWAUKEE ST
Practice Address - Street 2:UNIT #313
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3208
Practice Address - Country:US
Practice Address - Phone:414-507-8593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-22
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1036-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1036-132OtherDEPARTMENT OF REGULATION & LICENSING
WI1036-132OtherDEPARTMENT OF REGULATION & LICENSING