Individual
MARK MIXDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ICSW
Contact information
Practice address
1100 LAKE VIEW DR, WAUSAU, WI 54403-6785
(715) 848-4600
(715) 845-5398
Mailing address
1100 LAKE VIEW DR, WAUSAU, WI 54403-6785
(715) 848-4600
(715) 845-5398
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2541-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39661600
—
WI
Enumeration date
07/31/2006
Last updated
07/08/2007
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