1881633196 NPI number — MS. MARY JO ADLER MSSW LCSW

Table of content: CLAIRE E MCKINLEY M.D. (NPI 1639520216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881633196 NPI number — MS. MARY JO ADLER MSSW LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADLER
Provider First Name:
MARY
Provider Middle Name:
JO
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSSW LCSW
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:
1881633196
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
403 SUMMIT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAU CLAIRE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54701-4805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-834-9744
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
808 MAIN ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENOMONIE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54751-2735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-232-1116
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2006

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:  2372-123 , 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)

  • Identifier: 18936 . This is a "MMSI PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 39563700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1029428 . This is a "PREFERREDONE PIN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 44245 . This is a "SECURITY HEALTH PLAN ID" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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