Healthcare Provider Details

I. General information

NPI: 1740855675
Provider Name (Legal Business Name): NATOSHIA WAWIORKA APSW, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 RAMADA WAY
GREEN BAY WI
54304-5700
US

IV. Provider business mailing address

2830 RAMADA WAY
GREEN BAY WI
54304-5700
US

V. Phone/Fax

Practice location:
  • Phone: 920-497-6200
  • Fax:
Mailing address:
  • Phone: 920-497-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17117
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number134952
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: