Individual
TRICIA ANN VANDENAKKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, MSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
127830-121
WI
1041C0700X
Clinical Social Worker
Primary
7858-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1932430584
BCBSWI
WI
05
—
1932430584
—
WI
01
—
VANDETRI
MERCYCARE INSURANCE
WI
Enumeration date
01/21/2010
Last updated
10/29/2018
Update your record
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