1225191158 NPI number — DR. LINDA SUSAN NOER PH.D, MSW, LCSW,ACSW

Table of content: DR. LINDA SUSAN NOER PH.D, MSW, LCSW,ACSW (NPI 1225191158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225191158 NPI number — DR. LINDA SUSAN NOER PH.D, MSW, LCSW,ACSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOER
Provider First Name:
LINDA
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D, MSW, LCSW,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:
1225191158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1545 S LAYTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53215-1924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-671-5920
Provider Business Mailing Address Fax Number:
414-645-7850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2219 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RACINE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53405-3551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-637-9088
Provider Business Practice Location Address Fax Number:
262-637-3026
Provider Enumeration Date:
12/19/2006

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:  2353-123 , 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: 39556300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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