Provider Demographics
NPI:1548442791
Name:LANDVATTER-PESCHMAN, LINDA S (LCSW, LMFT, CEAP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:LANDVATTER-PESCHMAN
Suffix:
Gender:F
Credentials:LCSW, LMFT, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 N 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-1658
Mailing Address - Country:US
Mailing Address - Phone:414-774-4875
Mailing Address - Fax:
Practice Address - Street 1:1840 N 54TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-1658
Practice Address - Country:US
Practice Address - Phone:414-774-4875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1635-1231041C0700X
WI547-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist