1023670445 NPI number — MS. RABECCA CATHERINE COLE LCSW

Table of content: MS. RABECCA CATHERINE COLE LCSW (NPI 1023670445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023670445 NPI number — MS. RABECCA CATHERINE COLE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLE
Provider First Name:
RABECCA
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAUE
Provider Other First Name:
RABECCA
Provider Other Middle Name:
CATHERINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023670445
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N3943 LIBERTY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SULLIVAN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53178-9624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-285-3835
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1541 ANNEX RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53549-9803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-674-3105
Provider Business Practice Location Address Fax Number:
920-674-6113
Provider Enumeration Date:
07/05/2019

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:  9041-123 , 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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