Dereck Wolfgram, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9365-123 Issued in WI

Practice address

1230 Corporate Center Dr Ste 100
Oconomowoc, WI 53066-4883

Phone

(262) 999-3495

NPI assigned

Nov 27, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cornerstone Counseling Services, Inc

  • Mental Health Counselor
  • Brookfield, WI
  • NPI 1033127246
  Medicare reassignment NPD
• Rock River Community Clinic Inc

  • Federally Qualified Health Center (FQHC)
  • Whitewater, WI
  • NPI 1184220659
  NPD
• Rock River Community Clinic Inc

  • Federally Qualified Health Center (FQHC)
  • Watertown, WI
  • NPI 1427717115
  NPD

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

{
    "created_epoch": "1543276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771545600000",
    "number": "1174093744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1230 CORPORATE CENTER DR STE 100",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664883",
            "telephone_number": "262-999-3495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 CORPORATE CENTER DR STE 100",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664883",
            "telephone_number": "262-999-3495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLFGRAM",
        "first_name": "DERECK",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-11-27",
        "last_updated": "2026-02-20",
        "certification_date": "2026-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9365-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wisconsin Dental Group, S.C.
• Wisconsin Eating Disorder Specialists SC
• Sharon Wittman, RD
• Jill P Wohlfeil, MD
• Brian T Wojczak
• Ashley Wolfman, PTA
• Brigid Ann Wollersheim, LPC
• Rick Woodward, PA
• Rose Worden, LPC
• Douglas M Worth, PT

• Clinical Social Worker in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.