Provider Demographics
NPI:1124182126
Name:POEHLMANN, DAVID C (CSAC, LCSW, ICS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:POEHLMANN
Suffix:
Gender:
Credentials:CSAC, LCSW, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 N GRANDVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-6105
Mailing Address - Country:US
Mailing Address - Phone:262-549-6600
Mailing Address - Fax:262-549-6698
Practice Address - Street 1:5555 N PORT WASHINGTON RD STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4927
Practice Address - Country:US
Practice Address - Phone:262-999-3495
Practice Address - Fax:262-821-6180
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1364-132101YA0400X
WI7853-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI84767Medicare ID - Type UnspecifiedCLINIC #