Provider Demographics
NPI:1710973383
Name:NOBLE, LINDA L (CSAC, ICADC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:L
Last Name:NOBLE
Suffix:
Gender:F
Credentials:CSAC, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:FRIENDSHIP
Mailing Address - State:WI
Mailing Address - Zip Code:53934-9443
Mailing Address - Country:US
Mailing Address - Phone:608-339-4505
Mailing Address - Fax:608-339-4593
Practice Address - Street 1:108 E NORTH ST
Practice Address - Street 2:
Practice Address - City:FRIENDSHIP
Practice Address - State:WI
Practice Address - Zip Code:53934-9443
Practice Address - Country:US
Practice Address - Phone:608-339-4505
Practice Address - Fax:608-339-4593
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1698101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39344600Medicaid