1053634089 NPI number — MS. ANNE CATHERINE PACZESNY LCSW

Table of content: MS. ANNE CATHERINE PACZESNY LCSW (NPI 1053634089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053634089 NPI number — MS. ANNE CATHERINE PACZESNY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PACZESNY
Provider First Name:
ANNE
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:
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:
1053634089
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
890 ELM GROVE RD
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
ELM GROVE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53122-2528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-403-0524
Provider Business Mailing Address Fax Number:
262-285-3286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
890 ELM GROVE RD
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
ELM GROVE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53122-2528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-403-0524
Provider Business Practice Location Address Fax Number:
262-285-3286
Provider Enumeration Date:
03/04/2010

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:  2545 , 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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