Provider Demographics
NPI:1962699405
Name:MOHORICH-FLANDERS, VICKI LYNN (LCSW)
Entity type:Individual
Prefix:MS
First Name:VICKI LYNN
Middle Name:
Last Name:MOHORICH-FLANDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VICKI LYNN
Other - Middle Name:
Other - Last Name:MOHORICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16215 W HEATHERLY DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-9236
Mailing Address - Country:US
Mailing Address - Phone:414-217-5390
Mailing Address - Fax:
Practice Address - Street 1:4811 S 76TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4364
Practice Address - Country:US
Practice Address - Phone:262-330-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2093-132101Y00000X
WI12502101Y00000X
WI7609-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2093132OtherCSAC DEPT OF REG & LIC
WI12502OtherICS DEPT OF REG & LIC