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1700294881 NPI number — BRENDA WIESE MSW LICSW

NPI Number: 1700294881
Health Care Provider/Practitioner: BRENDA WIESE MSW LICSW

Information about “1700294881” NPI (BRENDA WIESE MSW LICSW) exists in 1700294881 in HTML format HTML  |  1700294881 in plain Text format TXT  |  1700294881 in PDF (Portable Document Format) PDF  |  1700294881 in an XML format XML  formats.

NPI Number : 1700294881 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700294881",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WIESE",
    "FirstName": "BRENDA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSW LICSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1617 HIGHWAY 12 E STE 230",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WILLMAR",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "56201-5816",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "320-894-2741",
    "MailingAddressFaxNumber": "320-205-0030",
    "FirstLinePracticeLocationAddress": "1617 HWY 12 E, SUITE 230",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WILLMAR",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "56201",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "320-894-2741",
    "PracticeLocationAddressFaxNumber": "320-205-0030",
    "EnumerationDate": "08/01/2014",
    "LastUpdateDate": "08/01/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "8625",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "8625",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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