Provider Demographics
NPI:1891730875
Name:DEMILL, LINDA MARIE (LCSW,RADC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:DEMILL
Suffix:
Gender:F
Credentials:LCSW,RADC
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 622
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-0622
Mailing Address - Country:US
Mailing Address - Phone:715-282-6555
Mailing Address - Fax:715-365-6768
Practice Address - Street 1:22 NORTH PELHAM STREET
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-0622
Practice Address - Country:US
Practice Address - Phone:715-365-6696
Practice Address - Fax:715-365-6768
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7069-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41007100Medicaid
WI000244050Medicare PIN