Individual
MR. WADE THOMAS KOSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
4402 S 68TH ST, SUITE 100, GREENFIELD, WI 53220-3479
(414) 321-4411
(414) 321-0552
Mailing address
7011 W SQUIRE AVE, GREENFIELD, WI 53220-4441
(414) 467-2477
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7176-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4095900
—
WI
01
—
7176-123
STATE LICENSE
WI
Enumeration date
11/15/2006
Last updated
07/08/2007
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