Provider Demographics
NPI:1376576231
Name:WEBSTER, EDMUND LEE (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:LEE
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-5524
Mailing Address - Country:US
Mailing Address - Phone:715-842-0944
Mailing Address - Fax:715-845-6477
Practice Address - Street 1:631 FOREST ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-5524
Practice Address - Country:US
Practice Address - Phone:715-842-0944
Practice Address - Fax:715-845-6477
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2167-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
280788OtherVALUEOPLTIONS
WI39571100Medicaid
WI62743OtherMULTIPLAN/WPPN
WI1990OtherSECURITY HEALTH PLAN
225540OtherMHN
WIW010420OtherCHAMPUS
P00033788OtherRAILROAD MEDICARE
WI39571100Medicaid