Provider Demographics
NPI:1164580833
Name:LANDE, STEVEN RICHARD (MSSW)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:RICHARD
Last Name:LANDE
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 S MADISON ST
Mailing Address - Street 2:STE. 580
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-1800
Mailing Address - Country:US
Mailing Address - Phone:920-730-4411
Mailing Address - Fax:920-730-4995
Practice Address - Street 1:1531 S MADISON ST
Practice Address - Street 2:STE. 580
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-1800
Practice Address - Country:US
Practice Address - Phone:920-730-4411
Practice Address - Fax:920-730-4995
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7657-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39717900Medicaid
WI39717900Medicaid
WIWI1309002Medicare PIN