Provider Demographics
NPI:1356763411
Name:VENEMAN-FIESCHKO, GERALDINE LUCIA
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:LUCIA
Last Name:VENEMAN-FIESCHKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GERALDINE
Other - Middle Name:LUCIA
Other - Last Name:VENEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:3526 SABAKA TRL
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-9565
Mailing Address - Country:US
Mailing Address - Phone:608-622-8020
Mailing Address - Fax:
Practice Address - Street 1:3526 SABAKA TRL
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-9565
Practice Address - Country:US
Practice Address - Phone:608-622-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8031-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical