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General NPI Number Information
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NPI Number | 1003968124
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Entity Type | Individual
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Provider Name | MARIE A NESEMANN LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/09/2014
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Provider Practice Location Address
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Address Line | 1509 S COMMERCIAL ST
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City | NEENAH
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State | WI
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Zip | 54956-6152
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Country | US
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Telephone | 920-722-8150
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Fax | 920-722-0142
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Provider Business Mailing Address
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Address Line | 778 MILLBROOK DR
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City | NEENAH
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State | WI
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Zip | 54956-1286
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Country | US
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Telephone | 920-727-1189
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 142-123
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License Number State | WI
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