Basic Information
| Provider Information | |||||||||
| NPI: | 1275281271 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERRILL | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | SAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7530 SPIDER LAKE RD | ||||||||
| Address2: | |||||||||
| City: | IRON RIVER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548474604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156827133 | ||||||||
| FaxNumber: | 7156857857 | ||||||||
| Practice Location | |||||||||
| Address1: | 53585 NOKOMIS RD | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548064272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156827133 | ||||||||
| FaxNumber: | 7156857857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2022 | ||||||||
| LastUpdateDate: | 03/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 19622 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.