Provider Demographics
NPI:1154667293
Name:LOCK, EMILY L (LCSW #8313-123)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:L
Last Name:LOCK
Suffix:
Gender:F
Credentials:LCSW #8313-123
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:L
Other - Last Name:VANCE-WELSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:420 7TH ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1222
Mailing Address - Country:US
Mailing Address - Phone:262-643-2391
Mailing Address - Fax:262-643-5342
Practice Address - Street 1:420 7TH ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1222
Practice Address - Country:US
Practice Address - Phone:626-432-3912
Practice Address - Fax:262-643-5342
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8313-123104100000X
WI128272-1211041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI8313OtherLICENSE