Healthcare Provider Details

I. General information

NPI: 1023404779
Provider Name (Legal Business Name): ERIN MIESS APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33875 INDIAN CREEK DR
MUSCODA WI
53573-5520
US

IV. Provider business mailing address

33875 INDIAN CREEK DR
MUSCODA WI
53573-5520
US

V. Phone/Fax

Practice location:
  • Phone: 608-604-4753
  • Fax:
Mailing address:
  • Phone: 608-604-4753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: