Healthcare Provider Details

I. General information

NPI: 1053852129
Provider Name (Legal Business Name): LAUREN WUENSTEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN AGUILAR

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 63RD ST
KENOSHA WI
53143-4454
US

IV. Provider business mailing address

2108 63RD ST
KENOSHA WI
53143-4454
US

V. Phone/Fax

Practice location:
  • Phone: 262-652-2406
  • Fax: 262-652-2408
Mailing address:
  • Phone: 262-652-2406
  • Fax: 262-652-2408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number130122-121
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9383-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: