Healthcare Provider Details

I. General information

NPI: 1053410456
Provider Name (Legal Business Name): WILMA J WERNICK MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WILMA J EBERT

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 W BROWN DEER RD SUITE 200
BROWN DEER WI
53209
US

IV. Provider business mailing address

3900 W BROWN DEER RD SUITE 200
BROWN DEER WI
53209
US

V. Phone/Fax

Practice location:
  • Phone: 414-540-2170
  • Fax: 414-540-2171
Mailing address:
  • Phone: 414-540-2170
  • Fax: 414-540-2171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number24036
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: