Provider Demographics
NPI:1194990655
Name:ZELLER, WENDY SUE (CICSW)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:SUE
Last Name:ZELLER
Suffix:
Gender:F
Credentials:CICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11540 N BUNTROCK AVE
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1856
Mailing Address - Country:US
Mailing Address - Phone:262-242-4769
Mailing Address - Fax:
Practice Address - Street 1:388 WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-9553
Practice Address - Country:US
Practice Address - Phone:262-573-9519
Practice Address - Fax:262-618-4547
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3054104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39690600Medicaid