Andrea Lee Behnke, APSW, SAC-IT

Primary specialty

Social WorkerTaxonomy code 104100000X

License

127964-121 Issued in WI

Practice address

230 Park St
Wautoma, WI 54982-9031

Phone

(920) 787-6550

Fax

(920) 787-0421

NPI assigned

Dec 16, 2015

Last updated

Dec 16, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Andrea Lee Hazelwood Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1450224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450224000000",
    "number": "1043675127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1230",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549821230",
            "telephone_number": "920-787-6600",
            "fax_number": "920-787-0465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 PARK ST",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549829031",
            "telephone_number": "920-787-6550",
            "fax_number": "920-787-0421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEHNKE",
        "first_name": "ANDREA",
        "middle_name": "LEE",
        "credential": "APSW, SAC-IT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-16",
        "last_updated": "2015-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "17649-130",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "127964-121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDREA",
            "last_name": "HAZELWOOD",
            "middle_name": "LEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jordan Ausen, HIS
• Laura L Baehnman, APNP
• Nathan L Barkalow, DC
• Terrence R Barkalow, DC
• Miguel Angel Barraza Chavez
• Robert K Bennot
• Terri L Billington, SAC-IT
• Bobbie J Bleskey, LPC, CSAC, ICS
• Dino J Bordini, D.D.S.
• David J Brown, DDS

• Social Worker in Wautoma, WI
• Providers in Wautoma, WI by specialty
• Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.