Active NPI
Mary Louise Fawcett, PH.D.
- Counselor
- Winona, MN
National Provider Identifier
1043428840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 2163
- Practice address
- 36261 Cedar Ridge Dr
Winona, MN 55987-5910 - Phone
- (507) 452-6945
- NPI assigned
- May 18, 2007
- Reactivated
- Oct 14, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 2163 | NC | Primary |
Addresses
Primary practice location
36261 Cedar Ridge Dr
Winona, MN 55987-5910
Mailing address
36261 Cedar Ridge Dr
Winona, MN 55987-5910
Phone (507) 452-6945
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2163 | NC | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602633600000",
"number": "1043428840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36261 CEDAR RIDGE DR",
"city": "WINONA",
"state": "MN",
"postal_code": "559875910",
"telephone_number": "507-452-6945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36261 CEDAR RIDGE DR",
"city": "WINONA",
"state": "MN",
"postal_code": "559875910",
"telephone_number": "507-452-6945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAWCETT",
"first_name": "MARY",
"middle_name": "LOUISE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-18",
"last_updated": "2020-10-14",
"certification_date": "2020-10-14",
"deactivation_date": "2012-11-19",
"reactivation_date": "2020-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NC",
"license": "2163",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winona, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.