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General NPI Number Information
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NPI Number | 1750492971
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Entity Type | Individual
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Provider Name | NANETTE DENISE COUNSELL-WILKE LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | N116 W16150 MAIN STREET
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City | GERMANTOWN
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State | WI
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Zip | 53022
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Country | US
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Telephone | 262-253-9420
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Fax | 262-532-2447
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Provider Business Mailing Address
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Address Line | 10201 W LINCOLN AVE SUITE 308
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City | WEST ALLIS
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State | WI
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Zip | 53227-2136
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Country | US
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Telephone | 414-329-7000
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Fax | 414-329-7010
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2506-123
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License Number State | WI
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