Provider Demographics
NPI:1013662709
Name:SKALECKI, WILLIAM JAMES
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:SKALECKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W69N463 FOXPOINTE AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2231
Mailing Address - Country:US
Mailing Address - Phone:262-707-3052
Mailing Address - Fax:
Practice Address - Street 1:120 N MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3353
Practice Address - Country:US
Practice Address - Phone:262-707-3052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
WI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional