Provider Demographics
NPI:1932430584
Name:VANDENAKKER, TRICIA ANN (LCSW, MSW)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:ANN
Last Name:VANDENAKKER
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:ANN
Other - Last Name:CAROLFI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:903 MINERAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2970
Mailing Address - Country:US
Mailing Address - Phone:608-756-5555
Mailing Address - Fax:608-756-0174
Practice Address - Street 1:414 DONOFRIO DR STE 330
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2846
Practice Address - Country:US
Practice Address - Phone:608-567-4462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI127830-121104100000X
WI7858-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1932430584OtherBCBSWI
WI1932430584Medicaid
WIVANDETRIOtherMERCYCARE INSURANCE
WI1932430584OtherBCBSWI