1871752188 NPI number — MS. KATHERINE ANN SWEENEY CSAC

Table of content: MS. KATHERINE ANN SWEENEY CSAC (NPI 1871752188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871752188 NPI number — MS. KATHERINE ANN SWEENEY CSAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWEENEY
Provider First Name:
KATHERINE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CSAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZANK
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CSAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871752188
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13304 37TH AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHIPPEWA FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54729-2543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-835-9110
Provider Business Mailing Address Fax Number:
715-830-4098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3136 CRAIG RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAU CLAIRE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54701-6109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-835-9110
Provider Business Practice Location Address Fax Number:
715-830-4098
Provider Enumeration Date:
06/03/2008

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: 171M00000X , with the licence number:  14896-130 , 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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