Provider Demographics
NPI:1750492971
Name:COUNSELL-WILKE, NANETTE DENISE (LCSW)
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:DENISE
Last Name:COUNSELL-WILKE
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 1:10201 W LINCOLN AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2136
Mailing Address - Country:US
Mailing Address - Phone:414-329-7000
Mailing Address - Fax:414-329-7010
Practice Address - Street 1:N116 W16150 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022
Practice Address - Country:US
Practice Address - Phone:262-253-9420
Practice Address - Fax:262-532-2447
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2506-123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39636500Medicaid
WI841580018Medicare ID - Type Unspecified