Provider Demographics
NPI:1891084133
Name:WOLKENSTEIN, ALAN STUART (MSW)
Entity Type:Individual
Prefix:PROF
First Name:ALAN
Middle Name:STUART
Last Name:WOLKENSTEIN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W DANDELION LN
Mailing Address - Street 2:800 W. DANDELION LANE
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3302
Mailing Address - Country:US
Mailing Address - Phone:262-243-5489
Mailing Address - Fax:
Practice Address - Street 1:800 W DANDELION LN
Practice Address - Street 2:800 W. DANDELION LANE
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3302
Practice Address - Country:US
Practice Address - Phone:262-243-5489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI458-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical