Healthcare Provider Details

I. General information

NPI: 1073803672
Provider Name (Legal Business Name): PAULA MARGARET WITT MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 RESEARCH PARK BLVD
MADISON WI
53719-1176
US

IV. Provider business mailing address

2601 TONTO TRL
VERONA WI
53593-9247
US

V. Phone/Fax

Practice location:
  • Phone: 608-232-3171
  • Fax: 608-262-9246
Mailing address:
  • Phone: 920-397-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7750-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: