Healthcare Provider Details

I. General information

NPI: 1083281596
Provider Name (Legal Business Name): NAOMI A PRESLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5247 NATURE DR
SUN PRAIRIE WI
53590-9254
US

IV. Provider business mailing address

5247 NATURE DR
SUN PRAIRIE WI
53590-9254
US

V. Phone/Fax

Practice location:
  • Phone: 608-239-5849
  • Fax:
Mailing address:
  • Phone: 608-239-5849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9694-123
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number807161
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: