Healthcare Provider Details

I. General information

NPI: 1609335926
Provider Name (Legal Business Name): CRYSTAL A WUETHRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2019
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 RED CEDAR ST STE 108
MENOMONIE WI
54751-2265
US

IV. Provider business mailing address

11017 MAIN ST
HEWITT WI
54441-9020
US

V. Phone/Fax

Practice location:
  • Phone: 612-217-0584
  • Fax:
Mailing address:
  • Phone: 715-387-1958
  • Fax: 715-387-1992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: