Healthcare Provider Details

I. General information

NPI: 1669449922
Provider Name (Legal Business Name): CHERI L WOTNOSKE CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 MAIN ST
DARLINGTON WI
53530-1395
US

IV. Provider business mailing address

627 MAIN ST
DARLINGTON WI
53530-1395
US

V. Phone/Fax

Practice location:
  • Phone: 608-776-4800
  • Fax: 608-776-4914
Mailing address:
  • Phone: 608-776-4800
  • Fax: 608-776-4914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13939
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: