Emma Phillips Myren, APSW

Key facts

NPI

1053950592

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Social Worker 1041C0700X

License

9765 (WI)

Practice address

710 Frederick St
Sun Prairie, WI 53590-2824

Phone

(608) 389-0330

NPI assigned

Jan 1, 2020

Sex

Female

Sole proprietor

No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oak Tree Counseling Clinical Social Worker · Sun Prairie, WI · NPI 1114643863
  NPD Authorized official CLINICAL
• Synergos Counseling Inc Multi-Specialty Clinic/Center · Madison, WI · NPI 1124545199
  NPD (past) SOCIAL WORKER

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

Other names

• Emma Kathleen Phillips Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 1, 2023.

{
    "created_epoch": "1577836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675209600000",
    "number": "1053950592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 FREDERICK ST",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535902824",
            "telephone_number": "608-215-6227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 FREDERICK ST",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535902824",
            "telephone_number": "608-389-0330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYREN",
        "first_name": "EMMA",
        "middle_name": "PHILLIPS",
        "credential": "APSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-01",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149024470",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMMA",
            "last_name": "PHILLIPS",
            "middle_name": "KATHLEEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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All providers in Sun Prairie, WI · Clinical Social Worker in Wisconsin