Provider Demographics
NPI:1730729302
Name:MANN, PATRICIA RANAYE (ATR, LPC, SAC-IT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:RANAYE
Last Name:MANN
Suffix:
Gender:F
Credentials:ATR, LPC, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 E HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:WI
Mailing Address - Zip Code:53235-4095
Mailing Address - Country:US
Mailing Address - Phone:414-419-1414
Mailing Address - Fax:
Practice Address - Street 1:2230 S KINNICKINNIC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-1330
Practice Address - Country:US
Practice Address - Phone:414-419-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18862-130101YA0400X
WI18-141221700000X
WI7083-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist