Provider Demographics
NPI:1649725888
Name:SA LIMBERG, INC
Entity type:Organization
Organization Name:SA LIMBERG, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MSLCSW
Authorized Official - Phone:715-356-6146
Mailing Address - Street 1:8618 HWY 51 N
Mailing Address - Street 2:P O BOX 86
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-9347
Mailing Address - Country:US
Mailing Address - Phone:715-356-6146
Mailing Address - Fax:715-358-9556
Practice Address - Street 1:1315 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:ARBOR VITAE
Practice Address - State:WI
Practice Address - Zip Code:54568-9778
Practice Address - Country:US
Practice Address - Phone:715-356-6146
Practice Address - Fax:715-358-9556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3396-125101YM0800X
WI2773-123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty