1902923568 NPI number — NORTHWEST COUNSELING AND GUIDANCE CLINIC- SIREN DAY TREATMENT

Table of content: (NPI 1902923568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902923568 NPI number — NORTHWEST COUNSELING AND GUIDANCE CLINIC- SIREN DAY TREATMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST COUNSELING AND GUIDANCE CLINIC- SIREN DAY TREATMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1902923568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIREN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54872-0309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-349-7069
Provider Business Mailing Address Fax Number:
888-625-8634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24996 ST RD 35
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIREN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54872-9239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-349-7069
Provider Business Practice Location Address Fax Number:
888-625-8634
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MAURER
Authorized Official First Name:
JACKIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE SUPERVISOR
Authorized Official Telephone Number:
715-349-7069

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X , with the licence number:  2290 , 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: HUMANA . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 42626 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 43004000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: VALUE OPTIONS . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7H956NO . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: PREFERRED ONE . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com