Provider Demographics
NPI:1912739319
Name:CONLISK-BOBULA, CLARE ANNA (LPC)
Entity type:Individual
Prefix:
First Name:CLARE
Middle Name:ANNA
Last Name:CONLISK-BOBULA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CLARE
Other - Middle Name:ANNA
Other - Last Name:CONLISK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:3325 S QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-2721
Mailing Address - Country:US
Mailing Address - Phone:314-662-0891
Mailing Address - Fax:
Practice Address - Street 1:W177N9856 RIVERCREST DR STE 112
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-4612
Practice Address - Country:US
Practice Address - Phone:314-662-0891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10340-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional