Provider Demographics
NPI:1689911604
Name:WICHMANN, SONIA LYNN (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:LYNN
Last Name:WICHMANN
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S19W37677 PASTEUR CT
Mailing Address - Street 2:
Mailing Address - City:DOUSMAN
Mailing Address - State:WI
Mailing Address - Zip Code:53118-8726
Mailing Address - Country:US
Mailing Address - Phone:262-433-6673
Mailing Address - Fax:
Practice Address - Street 1:200 W SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:WALES
Practice Address - State:WI
Practice Address - Zip Code:53183-9427
Practice Address - Country:US
Practice Address - Phone:262-433-6673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4907-125101YP2500X
WI917-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional