Organization · NPI-2

Acacia Clinic, INC.

Social Worker, Clinical · Milwaukee, WI

NPI number1417988973
StatusActive
Last updated in NPPESSep 11, 2025

Details

NPI
1417988973
Entity type
Organization (NPI-2)
Legal business name
Acacia Clinic, INC.
Organization subpart
No
Enumeration date
Jul 5, 2006
Last updated
Sep 11, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1041C0700X Social Worker, Clinical1066WIYes
101YM0800X Counselor, Mental Health1066WI
103TC0700X Psychologist, Clinical1066WI
103TC1900X Psychologist, Counseling1066WI
103T00000X Psychologist1066WI

Practice location

6040 W Lisbon Ave
Suite 102
Milwaukee, WI 53210-2116

Phone 414-871-9111 · Fax 414-871-9121

Mailing address

6040 W Lisbon Ave
Suite 102
Milwaukee, WI 53210-2116

Phone 414-871-9111 · Fax 414-871-9121

Authorized official

Deidra Lee Kozlowski
President
4148719111

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