Provider Demographics
NPI:1558473009
Name:WOOSENCRAFT-KEELER, ANN MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:WOOSENCRAFT-KEELER
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 1:1615 BARTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53090-2029
Mailing Address - Country:US
Mailing Address - Phone:262-334-5323
Mailing Address - Fax:262-334-4425
Practice Address - Street 1:1615 BARTON AVE
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53090-2029
Practice Address - Country:US
Practice Address - Phone:262-334-5323
Practice Address - Fax:262-334-4425
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7081-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43593600Medicaid