Healthcare Provider Details

I. General information

NPI: 1629711320
Provider Name (Legal Business Name): BETHANY SOLBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3073 S CHASE AVE STE 310
MILWAUKEE WI
53207-2667
US

IV. Provider business mailing address

2800 E ENTERPRISE AVE STE 333
APPLETON WI
54913-7889
US

V. Phone/Fax

Practice location:
  • Phone: 414-360-9635
  • Fax:
Mailing address:
  • Phone: 414-360-9635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12330-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: