1114095395 NPI number — CHIPPEWA COUNTY

Table of content: PHYLICIA ANDERSON MSW, LCSW (NPI 1174945992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114095395 NPI number — CHIPPEWA COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIPPEWA COUNTY
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:
6
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:
1114095395
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
711 N BRIDGE ST
Provider Second Line Business Mailing Address:
ROOM 305
Provider Business Mailing Address City Name:
CHIPPEWA FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54729-1845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-726-7788
Provider Business Mailing Address Fax Number:
715-726-7736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 N BRIDGE ST
Provider Second Line Business Practice Location Address:
ROOM 305
Provider Business Practice Location Address City Name:
CHIPPEWA FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54729-1845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-726-7788
Provider Business Practice Location Address Fax Number:
715-726-7736
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WINTER
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPT OF HUMAN SERVICES DIRECTOR
Authorized Official Telephone Number:
715-726-7788

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 43070900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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