Black, Georgia Rose

Black, Georgia Rose is an individual health care provider with primary practice located at 4855 S Moorland Rd Ste 150 , New Berlin WI 53151-7495. She recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Art Therapist, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Black, Georgia Rose can be contacted via phone (262) 432-7702.

Contact Information

Primary practice address
4855 S Moorland Rd Ste 150 New Berlin WI 53151-7495
Phone: (262) 432-7702
Fax: (262) 432-7795
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Art Therapist 221700000X
Behavioral Health & Social Service Providers / Professional 101YP2500X 4665 Wisconsin

Profile Details

NPI number 1497378947
LBN Legal business name Black, Georgia Rose
Credentials MS
Entity Individual
Sole proprietor 1 No
Enumeration date May 19th, 2020
Last updated Jan 18th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497378947 NPPES
Wisconsin MEDICAID 1497378947

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