Individual
MR. GERALD WISTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ICS, CSAC, MSW
Contact information
Practice address
300 FEMRITE DR, MONONA, WI 53716-3716
(608) 204-8491
Mailing address
7538 MID TOWN RD APT 101, MADISON, WI 53719-3454
(434) 270-6015
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1541-132
WI
104100000X
Social Worker
955-120
WI
Other
Enumeration date
04/13/2009
Last updated
06/08/2016
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