Krystal Bourgeois, BSW, SAC-IT
Counselor, Addiction (Substance Use Disorder) in Milwaukee, WI. Individual provider (NPI-1).
NPI number1982154779
StatusActive
Last updated in NPPESFeb 16, 2017
Details
- NPI
- 1982154779
- Entity type
- Individual (NPI-1)
- Name
- Ms. Krystal Bourgeois
- Credential
- BSW, SAC-IT
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 5, 2016
- Last updated
- Feb 16, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | 16764-130 | WI | Yes |
Practice location
2677 N 40th StMilwaukee, WI 53210-2505
Phone 414-447-1965 · Fax 414-447-1964
Mailing address
8801 W Oklahoma Ave Apt 210Milwaukee, WI 53227-4571
Phone 414-552-9244
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