=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700155512
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA POIST BIRD MSW,LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2011
-----------------------------------------------------
Last Update Date | 01/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 VISTA DR
-----------------------------------------------------
City | COTTAGE GROVE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53527-9366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-556-8545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 VISTA DR
-----------------------------------------------------
City | COTTAGE GROVE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53527-9366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | 6894-123
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------