Provider Demographics
NPI:1518091685
Name:SITTLER NELSON, SUE (LCSW)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:SITTLER NELSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 S 96TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227-4333
Mailing Address - Country:US
Mailing Address - Phone:414-321-6981
Mailing Address - Fax:
Practice Address - Street 1:316 N MILWAUKEE ST STE 302
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-5888
Practice Address - Country:US
Practice Address - Phone:414-704-1952
Practice Address - Fax:414-321-3519
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI315-123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40988500Medicaid
WI40988500Medicaid