Provider Demographics
NPI:1861880007
Name:POLNASZEK, ANDREA MURRAY (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MURRAY
Last Name:POLNASZEK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9536 COUNTY HWY S SOUTH
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54279-5225
Mailing Address - Country:US
Mailing Address - Phone:715-379-0858
Mailing Address - Fax:
Practice Address - Street 1:18484 BLAIR ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:WI
Practice Address - Zip Code:54773-8717
Practice Address - Country:US
Practice Address - Phone:715-495-8396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7344123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker