Individual
DERECK WOLFGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1230 CORPORATE CENTER DR STE 100, OCONOMOWOC, WI 53066-4883
(262) 999-3495
Mailing address
1230 CORPORATE CENTER DR STE 100, OCONOMOWOC, WI 53066-4883
(262) 999-3495
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
131050
WI
1041C0700X
Clinical Social Worker
Primary
9365-123
WI
Other
Enumeration date
11/27/2018
Last updated
02/20/2026
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