Provider Demographics
NPI:1245601772
Name:VANDEBROWN, TRAVIS H (MSW, LCSW, CSAC, ICS)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:H
Last Name:VANDEBROWN
Suffix:
Gender:M
Credentials:MSW, LCSW, CSAC, ICS
Other - Prefix:
Other - First Name:TRAVIS
Other - Middle Name:H
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 E WASHINGTON ST STE 2100
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-2503
Mailing Address - Country:US
Mailing Address - Phone:262-335-4583
Mailing Address - Fax:
Practice Address - Street 1:333 E WASHINGTON ST STE 2100
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-2503
Practice Address - Country:US
Practice Address - Phone:262-335-4583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132330-121104100000X
WI16017-132101YA0400X
WI11401-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100050428Medicaid