Healthcare Provider Details

I. General information

NPI: 1205533676
Provider Name (Legal Business Name): LINDSEY A WILICHOWSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSEY A JANIKOWSKI LCSW

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W7327 ANDERSON AVE
SHAWANO WI
54166-1143
US

IV. Provider business mailing address

211931 COUNTY ROAD J
HATLEY WI
54440-5041
US

V. Phone/Fax

Practice location:
  • Phone: 715-526-4700
  • Fax: 715-526-5542
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number132480
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11263
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: