Provider Demographics
NPI:1487724647
Name:NITKA, JOANN M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:M
Last Name:NITKA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 RAMADA WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5576
Mailing Address - Country:US
Mailing Address - Phone:920-482-2932
Mailing Address - Fax:800-892-6147
Practice Address - Street 1:3049 RAMADA WAY STE 200
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5576
Practice Address - Country:US
Practice Address - Phone:920-482-2932
Practice Address - Fax:800-892-6147
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6534-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical