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General NPI Number Information
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NPI Number | 1861880007
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Entity Type | Individual
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Provider Name | ANDREA MURRAY POLNASZEK LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 18484 BLAIR ST
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City | WHITEHALL
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State | WI
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Zip | 54773-8717
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Country | US
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Telephone | 715-495-8396
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Fax |
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Provider Business Mailing Address
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Address Line | 9536 COUNTY HWY S SOUTH
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54279-5225
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Country | US
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Telephone | 715-379-0858
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 7344123
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License Number State | WI
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