Provider Demographics
NPI:1871962423
Name:HOWEY, MANDY (PC-IT)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:HOWEY
Suffix:
Gender:F
Credentials:PC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 WASHINGTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-2102
Mailing Address - Country:US
Mailing Address - Phone:262-377-6276
Mailing Address - Fax:262-377-6289
Practice Address - Street 1:1971 WASHINGTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-2102
Practice Address - Country:US
Practice Address - Phone:262-377-6276
Practice Address - Fax:262-377-6289
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI127-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health