Provider Demographics
NPI:1447360276
Name:TROLLOP-NOVINSKA, REGINA ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:ANN
Last Name:TROLLOP-NOVINSKA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:ANN
Other - Last Name:TROLLOP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1160 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:FENNIMORE
Mailing Address - State:WI
Mailing Address - Zip Code:53809-1746
Mailing Address - Country:US
Mailing Address - Phone:608-822-5052
Mailing Address - Fax:608-996-2087
Practice Address - Street 1:6058 S CHESTNUT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-8947
Practice Address - Country:US
Practice Address - Phone:608-342-4853
Practice Address - Fax:608-342-4810
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI384-123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39613700Medicaid