Mr. Roger P. Northway MS LCSW
Full Name
Mr. Roger Patrick Northway MS LCSW
NPI Number
1053449173
NPI Type
Individual Provider
Gender
Male
Enumeration Date
03/01/2007
Specialties
(Taxonomies)Licenses
State
Wisconsin
Wisconsin
License Number
2661123
477125
Contact
Information
Purpose
Mailing
Location
Address
13105 W BLUEMOUND RD
13105 W BLUEMOUND RD
City
Brookfield
Brookfield
State
WI
WI
Postal Code
53005-8046
53005-8046
Country
US
US
Telephone Number
(262) 641-9790
(262) 641-9790
Identifiers
Identifier
39197200
Identifier State
WI
Identifier Issuer
Unknown
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 07/08/2007