Basic Information
| Provider Information | |||||||||
| NPI: | 1871949537 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SODERLING | ||||||||
| FirstName: | MARIAH | ||||||||
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| Credential: | SAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | JUNEAU COUNTY DEPT OF HUMAN SERVICES | ||||||||
| Address2: | 200 HICKORY ST | ||||||||
| City: | MAUSTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088472400 | ||||||||
| FaxNumber: | 6088479421 | ||||||||
| Practice Location | |||||||||
| Address1: | JUNEAU COUNTY DEPT OF HUMAN SERVICES | ||||||||
| Address2: | 200 HICKORY ST | ||||||||
| City: | MAUSTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088472400 | ||||||||
| FaxNumber: | 6088479421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2016 | ||||||||
| LastUpdateDate: | 08/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 16398-131 | WI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YA0400X | 17902-130 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.