Provider Demographics
NPI:1912177858
Name:WINTER, DAVID R (MS)
Entity Type:Individual
Prefix:PROF
First Name:DAVID
Middle Name:R
Last Name:WINTER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:PROF
Other - First Name:DAVID
Other - Middle Name:R
Other - Last Name:WINTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:10229 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3911
Mailing Address - Country:US
Mailing Address - Phone:414-453-6330
Mailing Address - Fax:414-453-6523
Practice Address - Street 1:10229 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-3911
Practice Address - Country:US
Practice Address - Phone:414-453-6330
Practice Address - Fax:414-453-6523
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI145-058104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI145-058OtherSTATE OF WISCONSIN