Active NPI
Mary Diane Wiatrowski, MSW, LCSW
- Social Worker
- Oshkosh, WI
National Provider Identifier
1457870644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 4176-123
- Practice address
- 404 N Main St Ste 612
Oshkosh, WI 54901-4953 - Phone
- (920) 385-1420
- Fax
- (866) 327-3295
- NPI assigned
- Sep 19, 2017
- Last updated
- Jul 11, 2018
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 4176-123 | WI | Primary |
Addresses
Primary practice location
404 N Main St Ste 612
Oshkosh, WI 54901-4953
Mailing address
1020 W 5TH Ave
Oshkosh, WI 54902-5728
Phone (920) 410-7156
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4176-123 | WI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531267200000",
"number": "1457870644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1020 W 5TH AVE",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549025728",
"telephone_number": "920-410-7156"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 N MAIN ST STE 612",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549014953",
"telephone_number": "920-385-1420",
"fax_number": "866-327-3295"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIATROWSKI",
"first_name": "MARY",
"middle_name": "DIANE",
"credential": "MSW, LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-19",
"last_updated": "2018-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "WI",
"license": "4176-123",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oshkosh, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.