Provider Demographics
NPI:1881690386
Name:STREYLE, JOHN R (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:STREYLE
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 1:320 17TH ST S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4925
Mailing Address - Country:US
Mailing Address - Phone:608-775-2287
Mailing Address - Fax:
Practice Address - Street 1:505 KING ST
Practice Address - Street 2:SUITE 025
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-9204
Practice Address - Country:US
Practice Address - Phone:608-785-7000
Practice Address - Fax:608-785-7477
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN130525OtherUCARE
WI39631200Medicaid
MN389K4STOtherBCBS-MN
MNHP46705OtherHEALTHPARTNERS
MN296318300Medicaid
WI000084005Medicare PIN