Mitchell Wade Kulawik, B.S., C.A.D.C

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

1374 Issued in IA

Practice address

505 5TH St Ste 520
Sioux City, IA 51101-1506

Phone

(402) 681-5000

Fax

(712) 277-2187

NPI assigned

Aug 20, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Science

State licenses

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

{
    "created_epoch": "1408492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588723200000",
    "number": "1922407485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 5TH ST STE 520",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511011506",
            "telephone_number": "402-681-5000",
            "fax_number": "712-277-2187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 5TH ST STE 520",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511011506",
            "telephone_number": "402-681-5000",
            "fax_number": "712-277-2187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KULAWIK",
        "first_name": "MITCHELL",
        "middle_name": "WADE",
        "credential": "B.S., C.A.D.C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-20",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IA",
            "license": "1374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922407485",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Sioux City, IA
• Providers in Sioux City, IA by specialty
• Addiction (Substance Use Disorder) Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.

Verify at the official NPI Registry.