1447360276 NPI number — MS. REGINA ANN TROLLOP-NOVINSKA LCSW

Table of content: MS. REGINA ANN TROLLOP-NOVINSKA LCSW (NPI 1447360276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447360276 NPI number — MS. REGINA ANN TROLLOP-NOVINSKA LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROLLOP-NOVINSKA
Provider First Name:
REGINA
Provider Middle Name:
ANN
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:
TROLLOP
Provider Other First Name:
GINA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1447360276
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1160 LINCOLN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FENNIMORE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53809-1746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-822-5052
Provider Business Mailing Address Fax Number:
608-996-2087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6058 S CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PLATTEVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53818-8947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-342-4853
Provider Business Practice Location Address Fax Number:
608-342-4810
Provider Enumeration Date:
08/30/2006

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: 101YM0800X , with the licence number:  384-123 , 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: 39613700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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