Healthcare Provider Details

I. General information

NPI: 1215481403
Provider Name (Legal Business Name): MARK HOHENWALD CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36100 GENESEE LAKE RD
OCONOMOWOC WI
53066-9201
US

IV. Provider business mailing address

W348N5160 ELM AVE
OKAUCHEE WI
53069-9757
US

V. Phone/Fax

Practice location:
  • Phone: 262-569-5515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2091-120
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: