Provider Demographics
NPI:1164068565
Name:NAMOWICZ, ARIEL MARIE (APSW)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:MARIE
Last Name:NAMOWICZ
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15285 WATERTOWN PLANK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2339
Mailing Address - Country:US
Mailing Address - Phone:414-552-8242
Mailing Address - Fax:
Practice Address - Street 1:15285 WATERTOWN PLANK RD STE 102
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2339
Practice Address - Country:US
Practice Address - Phone:414-552-8242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI96721231041C0700X
WI130743104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI9672-123OtherSTATE LICENSE
WI100095301Medicaid