Provider Demographics
NPI:1073399010
Name:MOCKENHAUPT, DOTTY (LCSW)
Entity Type:Individual
Prefix:
First Name:DOTTY
Middle Name:
Last Name:MOCKENHAUPT
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:W4031 COUNTY ROAD C
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:WI
Mailing Address - Zip Code:53570-9727
Mailing Address - Country:US
Mailing Address - Phone:630-862-8806
Mailing Address - Fax:
Practice Address - Street 1:W4031 COUNTY ROAD C
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:WI
Practice Address - Zip Code:53570-9727
Practice Address - Country:US
Practice Address - Phone:630-862-8806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490173381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical