Provider Demographics
NPI:1003968124
Name:NESEMANN, MARIE A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:A
Last Name:NESEMANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 MILLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-1286
Mailing Address - Country:US
Mailing Address - Phone:920-727-1189
Mailing Address - Fax:
Practice Address - Street 1:1509 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-6152
Practice Address - Country:US
Practice Address - Phone:920-722-8150
Practice Address - Fax:920-722-0142
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI142-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical