Provider Demographics
NPI:1124399225
Name:WACKER, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WACKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 E WASHINGTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3047
Mailing Address - Country:US
Mailing Address - Phone:608-241-4888
Mailing Address - Fax:608-241-4825
Practice Address - Street 1:1457 E WASHINGTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3047
Practice Address - Country:US
Practice Address - Phone:608-241-4888
Practice Address - Fax:608-241-4825
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker