Provider Demographics
NPI:1578596102
Name:WISKERCHEN, LINDA (COUNSELOR)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:WISKERCHEN
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11022 S 51ST ST
Mailing Address - Street 2:#100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-4308
Mailing Address - Country:US
Mailing Address - Phone:480-861-9624
Mailing Address - Fax:
Practice Address - Street 1:11022 S 51ST ST
Practice Address - Street 2:#100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4308
Practice Address - Country:US
Practice Address - Phone:480-861-9624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW12488101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical