Provider Demographics
NPI:1457178212
Name:CONTRERAS, ARIEL (MT-BC)
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:CONTRERAS
Suffix:
Gender:X
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 N SUMMIT AVE APT 308
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1239
Mailing Address - Country:US
Mailing Address - Phone:734-644-0461
Mailing Address - Fax:
Practice Address - Street 1:1139 S SUNNYSLOPE DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-3998
Practice Address - Country:US
Practice Address - Phone:414-485-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI19126225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist