Provider Demographics
NPI:1164752978
Name:WILKE KOHLMAN, TRACY L (APSW)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:L
Last Name:WILKE KOHLMAN
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:N5367 MAYFLOWER RD
Mailing Address - Street 2:
Mailing Address - City:SHIOCTON
Mailing Address - State:WI
Mailing Address - Zip Code:54170-8934
Mailing Address - Country:US
Mailing Address - Phone:920-738-7795
Mailing Address - Fax:920-986-3004
Practice Address - Street 1:N5367 MAYFLOWER RD
Practice Address - Street 2:
Practice Address - City:SHIOCTON
Practice Address - State:WI
Practice Address - Zip Code:54170-8934
Practice Address - Country:US
Practice Address - Phone:920-738-7795
Practice Address - Fax:920-986-3004
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI126738-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical