Provider Demographics
NPI:1265644405
Name:KOENINGS, CHARLES PETER (LCSW, SAC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:PETER
Last Name:KOENINGS
Suffix:
Gender:M
Credentials:LCSW, SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N88W17545 CHRISTMAN RD
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2600
Mailing Address - Country:US
Mailing Address - Phone:262-251-5128
Mailing Address - Fax:
Practice Address - Street 1:W247S10395 CENTER DR
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-9166
Practice Address - Country:US
Practice Address - Phone:262-662-5900
Practice Address - Fax:262-662-5688
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12673-131101YA0400X
WI1841-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39755000Medicaid