Active NPI
Heather Mitchell
- Clinical Social Worker
- Green Bay, WI
National Provider Identifier
1760868673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 9440-123
- Practice address
- 605 S Clay St
Green Bay, WI 54301-3414 - Phone
- (651) 414-1872
- NPI assigned
- Aug 3, 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 23122 | MN | |
| Clinical Social Worker | 1041C0700X | CSW.09925233 | CO | |
| Clinical Social Worker | 1041C0700X | 9440-123 | WI | Primary |
Addresses
Primary practice location
605 S Clay St
Green Bay, WI 54301-3414
Mailing address
605 S Clay St
Green Bay, WI 54301-3414
Phone (651) 414-1872
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 |
|---|---|---|---|
| CSW.09925233 | CO | MD | Clinical Social Worker |
| 23122 | MN | MD | Clinical Social Worker |
| 9440-123 | WI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607385600000",
"number": "1760868673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "605 S CLAY ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543013414",
"telephone_number": "651-414-1872"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "605 S CLAY ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543013414",
"telephone_number": "651-414-1872"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "HEATHER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-03",
"last_updated": "2020-12-08",
"certification_date": "2020-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "23122",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CO",
"license": "CSW.09925233",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "9440-123",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 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.