Provider Demographics
NPI:1598804890
Name:BISEK, DOROTHY MAE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:MAE
Last Name:BISEK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 BROADWAY
Mailing Address - Street 2:SUITE 170
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308
Mailing Address - Country:US
Mailing Address - Phone:320-762-0154
Mailing Address - Fax:
Practice Address - Street 1:1804 BROADWAY ST
Practice Address - Street 2:SUITE 170
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2718
Practice Address - Country:US
Practice Address - Phone:320-762-0154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health