Provider Demographics
NPI:1407454531
Name:EXNER, EMMA LOUISE (SAC-IT, CSW)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:LOUISE
Last Name:EXNER
Suffix:
Gender:F
Credentials:SAC-IT, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N115W16225 SAXONY SQ UNIT 1100
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-5678
Mailing Address - Country:US
Mailing Address - Phone:715-741-7202
Mailing Address - Fax:
Practice Address - Street 1:223 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4968
Practice Address - Country:US
Practice Address - Phone:715-741-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13196104100000X
WI19205101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker