Provider Demographics
NPI:1205671815
Name:MANSAVAGE, ARIANNA (MS)
Entity type:Individual
Prefix:
First Name:ARIANNA
Middle Name:
Last Name:MANSAVAGE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1681 N CASS ST APT 4
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4701
Mailing Address - Country:US
Mailing Address - Phone:608-438-8524
Mailing Address - Fax:
Practice Address - Street 1:1681 N CASS ST APT 4
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4701
Practice Address - Country:US
Practice Address - Phone:608-438-8524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WI7964226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health