Male or Other

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)

Code

1041C0700X
101YP2500X

Primary Taxonomy

No
No

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

Provider Address