1922170372 NPI number — MRS. MAUREEN A NEUVILLE LPC

Table of content: MRS. MAUREEN A NEUVILLE LPC (NPI 1922170372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922170372 NPI number — MRS. MAUREEN A NEUVILLE LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEUVILLE
Provider First Name:
MAUREEN
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BISSEN
Provider Other First Name:
MAUREEN
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, LPC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1922170372
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1005 OAK AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONALASKA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54650-2117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-780-2823
Provider Business Mailing Address Fax Number:
608-781-2924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 5TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 507
Provider Business Practice Location Address City Name:
LA CROSSE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54601-9200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-780-2823
Provider Business Practice Location Address Fax Number:
608-781-2924
Provider Enumeration Date:
11/14/2006

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: 101YM0800X , with the licence number:  3599-125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: LPC00916 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 40953700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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