Provider Demographics
NPI:1134618655
Name:WAHL, ELIZABETH (MSSW, CAPSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WAHL
Suffix:
Gender:F
Credentials:MSSW, CAPSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:MATINKUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:128 EAST OLIN AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1467
Mailing Address - Country:US
Mailing Address - Phone:608-252-1320
Mailing Address - Fax:608-252-1333
Practice Address - Street 1:128 EAST OLIN AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1467
Practice Address - Country:US
Practice Address - Phone:608-252-1320
Practice Address - Fax:608-252-1333
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI127535-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker