Provider Demographics
NPI:1053338806
Name:WILGOCKI, JENNIFER LYNNE (MS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:WILGOCKI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3463
Mailing Address - Country:US
Mailing Address - Phone:608-237-8000
Mailing Address - Fax:608-237-8005
Practice Address - Street 1:6300 UNIVERSITY AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3463
Practice Address - Country:US
Practice Address - Phone:608-237-8000
Practice Address - Fax:608-237-8005
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3070-123104100000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39664300Medicare ID - Type Unspecified