Individual
MR. TRAVIS H VANDEBROWN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW, CSAC, ICS
Contact information
Practice address
333 E WASHINGTON ST STE 2100, WEST BEND, WI 53095-2503
(262) 335-4583
Mailing address
333 E WASHINGTON ST STE 2100, WEST BEND, WI 53095-2503
(262) 335-4583
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16017-132
WI
104100000X
Social Worker
132330-121
WI
1041C0700X
Clinical Social Worker
Primary
11401-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100050428
—
WI
Enumeration date
10/09/2015
Last updated
09/26/2023
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