Provider Demographics
NPI:1477714939
Name:VANDER WIELEN, CHRISTINE MARIE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:VANDER WIELEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 KENWOOD CTR
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1134
Mailing Address - Country:US
Mailing Address - Phone:920-720-8872
Mailing Address - Fax:920-720-8873
Practice Address - Street 1:1476 KENWOOD CTR
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1134
Practice Address - Country:US
Practice Address - Phone:920-720-8872
Practice Address - Fax:920-720-8873
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1453-1211041C0700X
WI7710-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical