Marie Annette Basty, LICENSED CLINICAL SO
Individual provider Active NPI Clinical Social Worker · Hayward, WI
NPI 1992912422 · NPPES record last updated Mar 13, 2022
Key facts
- NPI
- 1992912422
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 7686-123 (WI)
- Practice address
- Lac Courte Oreilles Community Health Center
13380 W Trepania Road
Hayward, WI 54843 - Phone
- (715) 638-5100
- NPI assigned
- May 16, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 127176 | WI | MD | Clinical Social Worker |
| 7686-123 | WI | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 127176 | WI | |
| Clinical Social Worker | 1041C0700X | 7686-123 | WI | Yes |
Addresses
Primary practice location
Lac Courte Oreilles Community Health Center
13380 W Trepania Road
Hayward, WI 54843
Mailing address
13380 W Trepania Road
Hayward, WI 54843
Phone (715) 497-0790
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43716300 | Medicaid | WI |
Other providers in Hayward, WI
- Julie A Arnett
- Ashland Audiology LLC
- Emma Barner
- Yessica Barron
- Tanya M. Barton
- John William Bauer
- Susan Beth Bauer
- Jamie Lea Taylor Bell
- Gina Marie Benson
- Rae Jean Bergner
All providers in Hayward, WI · Clinical Social Worker in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.