1528011715 NPI number — MS. CYNTHIA ANNE GROTA MSSW, ACSW

Table of content: MS. CYNTHIA ANNE GROTA MSSW, ACSW (NPI 1528011715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528011715 NPI number — MS. CYNTHIA ANNE GROTA MSSW, ACSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROTA
Provider First Name:
CYNTHIA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSSW, ACSW
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:
1528011715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 231
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEILLSVILLE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54456-0231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-743-4369
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
517 COURT ST
Provider Second Line Business Practice Location Address:
ROOM 503
Provider Business Practice Location Address City Name:
NEILLSVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54456-1971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-743-5208
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2006

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: 1041C0700X , with the licence number:  829-123 , 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)





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