Provider Demographics
NPI:1013017169
Name:MLODZIK, THOMAS G (MSW, LCSW, LMFT, CAD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:MLODZIK
Suffix:
Gender:M
Credentials:MSW, LCSW, LMFT, CAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 E NEWPORT AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2984
Mailing Address - Country:US
Mailing Address - Phone:414-961-5520
Mailing Address - Fax:
Practice Address - Street 1:2015 E NEWPORT AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2984
Practice Address - Country:US
Practice Address - Phone:414-961-5520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12418101YA0400X
WI6995-1231041C0700X
WI555-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI12418OtherCADCIII
WI39757800Medicaid
WI6995-123OtherLCSW
WI555-124OtherLMFT