Healthcare Provider Details

I. General information

NPI: 1053331090
Provider Name (Legal Business Name): MARIANNE E WEBERS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 REED AVE
MANITOWOC WI
54220-2020
US

IV. Provider business mailing address

PO BOX 2290
MANITOWOC WI
54221-2290
US

V. Phone/Fax

Practice location:
  • Phone: 920-320-8600
  • Fax: 920-380-8662
Mailing address:
  • Phone: 920-320-2591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number710-123
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierS31079
Identifier TypeOTHER
Identifier State
Identifier IssuerCIGNA
# 2
Identifier29575
Identifier TypeOTHER
Identifier State
Identifier IssuerNETWORK HEALTH PLAN
# 3
Identifier39613100
Identifier TypeMEDICAID
Identifier StateWI
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: