Provider Demographics
NPI:1194024166
Name:MANTHEY-WANEK, SARA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:MANTHEY-WANEK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANN
Other - Last Name:MANTHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1825 RIVERSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3825
Mailing Address - Country:US
Mailing Address - Phone:920-272-8234
Mailing Address - Fax:920-437-4067
Practice Address - Street 1:1825 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3825
Practice Address - Country:US
Practice Address - Phone:920-272-8234
Practice Address - Fax:920-437-4067
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1849-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1194024166Medicare NSC