Healthcare Provider Details

I. General information

NPI: 1750500062
Provider Name (Legal Business Name): LINDA WUESTENBERG MED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 E GORHAM ST
MADISON WI
53703-1524
US

IV. Provider business mailing address

25 KESSEL CT STE 105
MADISON WI
53711-6227
US

V. Phone/Fax

Practice location:
  • Phone: 608-280-2700
  • Fax:
Mailing address:
  • Phone: 608-280-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2021
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4284
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: