Provider Demographics
NPI:1205533676
Name:WILICHOWSKI, LINDSEY A (LCSW)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:A
Last Name:WILICHOWSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:A
Other - Last Name:JANIKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:211931 COUNTY ROAD J
Mailing Address - Street 2:
Mailing Address - City:HATLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54440-5041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:W7327 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-1143
Practice Address - Country:US
Practice Address - Phone:715-526-4700
Practice Address - Fax:715-526-5542
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1324801041C0700X
WI112631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100236738Medicaid
WI11263OtherSTATE OF WISCONSIN
WI132480OtherSTATE OF WISCONSIN