NPI 1417988973 · live from the CMS NPI Registry
Acacia Clinic, INC.
Social Worker, Clinical in Milwaukee, WI. National Provider Identifier 1417988973, active.
NPI record
| NPI | 1417988973 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Social Worker, Clinical 1041C0700X |
| Practice location | 6040 W Lisbon Ave, Suite 102, Milwaukee, WI 53210 |
| Practice phone | 414-871-9111 |
| Enumerated | July 5, 2006 |
| Last updated | September 11, 2025 |
| Authorized official | Deidra Kozlowski, President |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Counselor, Mental Health | 101YM0800X | 1066 (WI) |
| Psychologist, Clinical | 103TC0700X | 1066 (WI) |
| Psychologist, Counseling | 103TC1900X | 1066 (WI) |
| Psychologist | 103T00000X | 1066 (WI) |
| Social Worker, Clinical primary | 1041C0700X | 1066 (WI) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.