Healthcare Provider Details

I. General information

NPI: 1689724577
Provider Name (Legal Business Name): LINDA MARIE SIME MSSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 N US HIGHWAY 51
JANESVILLE WI
53545-0726
US

IV. Provider business mailing address

8647 N TOLLES RD
EVANSVILLE WI
53536-8853
US

V. Phone/Fax

Practice location:
  • Phone: 608-757-5220
  • Fax: 608-757-5231
Mailing address:
  • Phone: 608-882-9959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number311-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: