Provider Demographics
NPI:1023110319
Name:WELLMAN-KRAUSE, ANN MARIE (MSW)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:WELLMAN-KRAUSE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:WELLMAN-KRAUSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2717 N GRANDVIEW BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1672
Mailing Address - Country:US
Mailing Address - Phone:262-544-6486
Mailing Address - Fax:262-544-6377
Practice Address - Street 1:2717 N GRANDVIEW BLVD
Practice Address - Street 2:#303
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188
Practice Address - Country:US
Practice Address - Phone:262-544-6486
Practice Address - Fax:262-544-6377
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI436123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39255400Medicaid