Active NPI
Mark Sandberg
- Clinical Social Worker
- Viroqua, WI
National Provider Identifier
1316486731
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 9208-123
- Practice address
- 118 E Jefferson St
Viroqua, WI 54665-1613 - Phone
- (608) 632-3286
- NPI assigned
- Feb 17, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Clinical Social Worker | 1041C0700X | 9208-123 | WI | Primary |
Addresses
Primary practice location
118 E Jefferson St
Viroqua, WI 54665-1613
Mailing address
PO Box 11
Viroqua, WI 54665-0011
Phone (608) 632-3286
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 |
|---|---|---|---|
| 9208-123 | WI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sandberg Counseling LLC | Mental Health | Current | Accepting new patients |
| Driftless Counseling LLC | Clinical | Current | Accepting new patients |
Locations
118 E Jefferson St
Viroqua, WI 54665
Phone (608) 606-6789
318 Fairlane Dr
Viroqua, WI 54665
Phone (608) 637-5251
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1487289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581552000000",
"number": "1316486731",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 11",
"city": "VIROQUA",
"state": "WI",
"postal_code": "546650011",
"telephone_number": "608-632-3286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 E JEFFERSON ST",
"city": "VIROQUA",
"state": "WI",
"postal_code": "546651613",
"telephone_number": "608-632-3286"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDBERG",
"first_name": "MARK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-02-17",
"last_updated": "2020-02-13",
"certification_date": "2020-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "9208-123",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Viroqua, WI
- Jennifer Rae Robson, PHARMD
- Kali Roesler, COTA
- Carol Elizabeth Rohr, RN
- Colleen Clarice Ruebsamen, OTR, CHT
- Sandberg Counseling LLC
- Dean B Saner, PSYD
- Scenic Bluffs Health Center, Inc
- Scenic Bluffs Health Center, Inc (Scenic Bluffs Community Health Centers)
- Jeffrey P Scheidt, CRNA
- Erin Marie Scherer-Derosa, PT, DPT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.