Provider Demographics
NPI:1124182126
Name:POEHLMANN, DAVID (CSAC, APSW,ICS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:POEHLMANN
Suffix:
Gender:M
Credentials:CSAC, APSW,ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 N GRANDVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-6105
Mailing Address - Country:US
Mailing Address - Phone:262-549-6600
Mailing Address - Fax:262-549-6698
Practice Address - Street 1:2422 N GRANDVIEW BLVD
Practice Address - Street 2:SUITE 501
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-6105
Practice Address - Country:US
Practice Address - Phone:262-928-6900
Practice Address - Fax:262-928-3815
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1364101YA0400X
WI127730104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI84767Medicare ID - Type UnspecifiedCLINIC #