=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124757570
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEIGHA SUZANNE JOLIN MSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2022
-----------------------------------------------------
Last Update Date | 02/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1630 N CHIPPEWA DR
-----------------------------------------------------
City | RHINELANDER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54501-9503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-361-2805
-----------------------------------------------------
Fax | 715-361-2920
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5738 BREEZY PINE RD
-----------------------------------------------------
City | RHINELANDER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54501-7504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-588-0488
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 11682-123
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------