Provider Demographics
NPI:1215481403
Name:HOHENWALD, MARK (CSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HOHENWALD
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W348N5160 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:OKAUCHEE
Mailing Address - State:WI
Mailing Address - Zip Code:53069-9757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36100 GENESEE LAKE RD
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-9201
Practice Address - Country:US
Practice Address - Phone:262-569-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2091-120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker