Healthcare Provider Details

I. General information

NPI: 1861345167
Provider Name (Legal Business Name): JODIE MUTH MSW, CAPSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 5TH AVE S STE 421
LA CROSSE WI
54601-4096
US

IV. Provider business mailing address

115 5TH AVE S STE 421
LA CROSSE WI
54601-4096
US

V. Phone/Fax

Practice location:
  • Phone: 608-769-0127
  • Fax:
Mailing address:
  • Phone: 608-769-0127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number129248-121
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number129248-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: