Provider Demographics
NPI:1447460217
Name:SVEDA, DOUGLAS E (MSW)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:E
Last Name:SVEDA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-1606
Mailing Address - Country:US
Mailing Address - Phone:414-258-2734
Mailing Address - Fax:
Practice Address - Street 1:5812 W BURNHAM ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53219-1524
Practice Address - Country:US
Practice Address - Phone:414-543-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI339-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39703200Medicaid