Provider Demographics
NPI:1013800119
Name:WOLLER, MADILYN RAE (MS)
Entity type:Individual
Prefix:
First Name:MADILYN
Middle Name:RAE
Last Name:WOLLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MADILYN
Other - Middle Name:RAE
Other - Last Name:UNGERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1810 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-3492
Mailing Address - Country:US
Mailing Address - Phone:715-848-4884
Mailing Address - Fax:715-848-2106
Practice Address - Street 1:1810 N 2ND ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-3492
Practice Address - Country:US
Practice Address - Phone:715-848-4884
Practice Address - Fax:715-848-2106
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1153228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist