Active NPI
Carol Polzin
- Professional Counselor
- Gaylord, MN
National Provider Identifier
1285021667
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- CC00969
- Practice address
- 112 5TH St
Gaylord, MN 55334-4478 - Phone
- (507) 235-6070
- Fax
- (507) 235-6074
- NPI assigned
- Apr 23, 2015
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | CC00969 | MN | Primary |
Addresses
Primary practice location
112 5TH St
Gaylord, MN 55334-4478
Mailing address
112 5TH St
Gaylord, MN 55334-4478
Phone (507) 235-6070
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285021667 | Medicaid | MN |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CC00969 | MN | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494374400000",
"number": "1285021667",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 5TH ST",
"city": "GAYLORD",
"state": "MN",
"postal_code": "553344478",
"telephone_number": "507-235-6070",
"fax_number": "507-235-6074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 5TH ST",
"city": "GAYLORD",
"state": "MN",
"postal_code": "553344478",
"telephone_number": "507-235-6070",
"fax_number": "507-235-6074"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLZIN",
"first_name": "CAROL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-04-23",
"last_updated": "2017-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MN",
"license": "CC00969",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1285021667",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gaylord, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.