Provider Demographics
NPI:1306938527
Name:WOLLIN, TRISHA (LCSW; SAC)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:WOLLIN
Suffix:
Gender:F
Credentials:LCSW; SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N SUNNYSLOPE RD, STE 372
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4806
Mailing Address - Country:US
Mailing Address - Phone:414-302-1233
Mailing Address - Fax:262-788-9662
Practice Address - Street 1:150 N SUNNYSLOPE RD, STE 372
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4806
Practice Address - Country:US
Practice Address - Phone:414-302-1233
Practice Address - Fax:262-788-9662
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14168101YA0400X
WI14168-131101YM0800X
WI8709-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1306938527Medicaid