Provider Demographics
NPI:1235201914
Name:KOSKI, WADE THOMAS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WADE
Middle Name:THOMAS
Last Name:KOSKI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7011 W SQUIRE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4441
Mailing Address - Country:US
Mailing Address - Phone:414-467-2477
Mailing Address - Fax:
Practice Address - Street 1:4402 S 68TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-3479
Practice Address - Country:US
Practice Address - Phone:414-321-4411
Practice Address - Fax:414-321-0552
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7176-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7176-123OtherSTATE LICENSE
WI4095900Medicaid