MEDICARE: CANDACE WENDLICK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	7057-123	WI

General Provider Information

NPI Number	:	1306921440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE WENDLICK LCSW

Provider Business Mailing Address
First Line	:	6791 N GREEN BAY AVE
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-3422
Country	:	US
Telephone Number	:	414-228-4800
Fax Number	:	414-247-0894

Provider Business Practice Location Address
First Line	:	6791 N GREEN BAY AVE
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-3422
Country	:	US
Telephone Number	:	414-228-4800
Fax Number	:	414-247-0894

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	06/09/2009

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