Provider Demographics
NPI:1295831345
Name:AEBLI, ROBERT (CICSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:AEBLI
Suffix:
Gender:M
Credentials:CICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 N 25TH ST E
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-5269
Mailing Address - Country:US
Mailing Address - Phone:715-393-8216
Mailing Address - Fax:715-392-6055
Practice Address - Street 1:39 N 25TH ST E
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5269
Practice Address - Country:US
Practice Address - Phone:715-393-8216
Practice Address - Fax:715-392-6055
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI65961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39781900Medicaid
WI39781900Medicaid