Doctor Name: | CHARLENE WAHLEN |
NPI Number: | 1164827895 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 1116 |
Business Practice Address: | 3040 93rd St Sturtevant, WI - 531772602 |
Business Phone Number: | 4143331256 |
Business Fax Number: | |
Mailing Address: | 1178 Gardner Street, TWO RIVERS |
State: | WI |
Postal Code: | 54241 |
Phone Number: | 9207933100 |
Fax Number: | |
NPI Enumeration Date: | 10/23/2014 |
NPI Last Update Date: | 10/23/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 1116 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |