Basic Information
| Provider Information | |||||||||
| NPI: | 1891730875 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEMILL | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | LCSW,RADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 622 | ||||||||
| Address2: | |||||||||
| City: | RHINELANDER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545010622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152826555 | ||||||||
| FaxNumber: | 7153656768 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 NORTH PELHAM STREET | ||||||||
| Address2: | |||||||||
| City: | RHINELANDER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545010622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153656696 | ||||||||
| FaxNumber: | 7153656768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 04/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 7069-123 | WI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 41007100 | 05 | WI | MEDICAID |