Individual
MARK EDWARD WAKEFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, MBA
Contact information
Practice address
1709 S PARK ST, MADISON, WI 53713-1200
(608) 223-0017
(608) 223-0019
Mailing address
PO BOX 7370, MADISON, WI 53707-7370
(608) 223-0017
(608) 223-0019
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
13764132
WI
101YM0800X
Mental Health Counselor
Primary
479226
WI
Other
Enumeration date
12/01/2008
Last updated
12/01/2008
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