Carole Anne Widick, L.P.

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

LP1899 Issued in MN

Practice address

110 2ND St S Ste 301
Waite Park, MN 56387-1314

Phone

(320) 252-2976

Fax

(320) 656-1570

NPI assigned

Jul 17, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210723200000",
    "number": "1770501843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 2ND ST S STE 301",
            "city": "WAITE PARK",
            "state": "MN",
            "postal_code": "563871314",
            "telephone_number": "320-252-2976",
            "fax_number": "320-656-1570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 2ND ST S STE 301",
            "city": "WAITE PARK",
            "state": "MN",
            "postal_code": "563871314",
            "telephone_number": "320-252-2976",
            "fax_number": "320-656-1570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDICK",
        "first_name": "CAROLE",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "L.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2008-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "LP1899",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "491351500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Counseling Psychologist in Waite Park, MN
• Providers in Waite Park, MN by specialty
• Counseling Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.