Healthcare Provider Details

I. General information

NPI: 1770242281
Provider Name (Legal Business Name): BENJAMIN H FENDRICH LCSW, CSAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2021
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6915 N MILWAUKEE RIVER PKWY
GLENDALE WI
53209-2907
US

IV. Provider business mailing address

6915 N MILWAUKEE RIVER PKWY
GLENDALE WI
53209-2907
US

V. Phone/Fax

Practice location:
  • Phone: 414-745-9889
  • Fax:
Mailing address:
  • Phone: 414-745-9889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16418
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9245
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9245
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: