Provider Demographics
NPI:1528885639
Name:WENZELOW, BRIGID KATHLEEN (LCSW)
Entity type:Individual
Prefix:
First Name:BRIGID
Middle Name:KATHLEEN
Last Name:WENZELOW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRIGID
Other - Middle Name:KATHLEEN
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APSW, LCSW
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:WI
Mailing Address - Zip Code:54136-0054
Mailing Address - Country:US
Mailing Address - Phone:920-383-1194
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 54
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:WI
Practice Address - Zip Code:54136-0054
Practice Address - Country:US
Practice Address - Phone:920-383-1194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-21
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11286-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical