1538497169 NPI number — MRS. BRIGETTE SIMONEAU CHIZEK MSW

Table of content: MRS. BRIGETTE SIMONEAU CHIZEK MSW (NPI 1538497169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538497169 NPI number — MRS. BRIGETTE SIMONEAU CHIZEK MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIZEK
Provider First Name:
BRIGETTE
Provider Middle Name:
SIMONEAU
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538497169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARABOO
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53913-0029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-355-4200
Provider Business Mailing Address Fax Number:
608-524-7990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REEDSBURG
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53959-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-355-4200
Provider Business Practice Location Address Fax Number:
608-524-7990
Provider Enumeration Date:
11/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  126767-121 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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