Provider Demographics
NPI:1548989411
Name:ABBOTT, AUSTANN DIXIE JEAN (CSW)
Entity type:Individual
Prefix:
First Name:AUSTANN
Middle Name:DIXIE JEAN
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:MCFARLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53558-0092
Mailing Address - Country:US
Mailing Address - Phone:608-301-5376
Mailing Address - Fax:608-200-2417
Practice Address - Street 1:1021 N SUPERIOR AVE STE 10
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-1192
Practice Address - Country:US
Practice Address - Phone:608-886-9023
Practice Address - Fax:608-200-2417
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12992-120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker