1386940609 NPI number — HILARY ANNE PICK MA, LPC, CSAC, CS-IT

Table of content: HILARY ANNE PICK MA, LPC, CSAC, CS-IT (NPI 1386940609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386940609 NPI number — HILARY ANNE PICK MA, LPC, CSAC, CS-IT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PICK
Provider First Name:
HILARY
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC, CSAC, CS-IT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386940609
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1155 N MAYFAIR RD
Provider Second Line Business Mailing Address:
DEPARTMENT OF PSYCHIATRY
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53226-3462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-955-8900
Provider Business Mailing Address Fax Number:
414-955-6299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1155 N MAYFAIR RD
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PSYCHIATRY
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-3462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-955-8900
Provider Business Practice Location Address Fax Number:
414-955-6299
Provider Enumeration Date:
02/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  15479-132 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 4361-125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1386940609 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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