1750492971 NPI number — NANETTE DENISE COUNSELL-WILKE LCSW

Table of content: NANETTE DENISE COUNSELL-WILKE LCSW (NPI 1750492971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750492971 NPI number — NANETTE DENISE COUNSELL-WILKE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COUNSELL-WILKE
Provider First Name:
NANETTE
Provider Middle Name:
DENISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750492971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10201 W LINCOLN AVE
Provider Second Line Business Mailing Address:
SUITE 308
Provider Business Mailing Address City Name:
WEST ALLIS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53227-2136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-329-7000
Provider Business Mailing Address Fax Number:
414-329-7010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
N116 W16150 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-253-9420
Provider Business Practice Location Address Fax Number:
262-532-2447
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  2506-123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 39636500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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