Provider Demographics
NPI:1366461535
Name:WIJAS YERGES, PAULETTE M
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:M
Last Name:WIJAS YERGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAULETTE
Other - Middle Name:M
Other - Last Name:WIJAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:BLANCHARDVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53516-0145
Mailing Address - Country:US
Mailing Address - Phone:608-827-7100
Mailing Address - Fax:608-827-7101
Practice Address - Street 1:304 S MAIN STREET
Practice Address - Street 2:P O BOX 145
Practice Address - City:BLANCHARDVILLE
Practice Address - State:WI
Practice Address - Zip Code:53516-9002
Practice Address - Country:US
Practice Address - Phone:608-341-8600
Practice Address - Fax:608-341-8600
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1932-1231041C0700X
WI12737101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39630100Medicaid