Provider Demographics
NPI:1609859495
Name:PANKRATZ, JAMES M (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:PANKRATZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 N 60TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-1641
Mailing Address - Country:US
Mailing Address - Phone:414-771-2881
Mailing Address - Fax:414-771-6095
Practice Address - Street 1:2021 N 60TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-1641
Practice Address - Country:US
Practice Address - Phone:414-771-2881
Practice Address - Fax:414-771-6095
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI175-125104100000X, 1041C0700X
WI169124106H00000X
WI175123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39612200Medicaid
WI39612200Medicaid