Healthcare Provider Details

I. General information

NPI: 1437644259
Provider Name (Legal Business Name): BETHANY MARIE HART LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETHANY MARIE FRITSCH

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MAIN ST FL 5
LA CROSSE WI
54601-9207
US

IV. Provider business mailing address

101 W OAK ST
SPARTA WI
54656-1712
US

V. Phone/Fax

Practice location:
  • Phone: 608-397-0192
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12723-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: