Healthcare Provider Details

I. General information

NPI: 1437597879
Provider Name (Legal Business Name): PAIGE LEIGH WANDLING BSW-LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 SAINT ANDREW ST STE 100
LA CROSSE WI
54603-3301
US

IV. Provider business mailing address

P.O BOX 267 3839 COUNTY HWY 3
BROWNSVILLE MN
55919-0276
US

V. Phone/Fax

Practice location:
  • Phone: 608-785-6266
  • Fax:
Mailing address:
  • Phone: 608-790-6174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number11183-120
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: