Individual
PHOENIX VAN LAANEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
10207
WI
1041C0700X
Clinical Social Worker
Primary
10207
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10207
STATE LICENSE
WI
Enumeration date
08/06/2018
Last updated
06/04/2025
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