Healthcare Provider Details

I. General information

NPI: 1215578828
Provider Name (Legal Business Name): BETHANY JOY WOYCHIK LCSW, SAC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 07/11/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 ENGEL ST STE 201
MONONA WI
53713-4822
US

IV. Provider business mailing address

826 DEMPSTER ST
FORT ATKINSON WI
53538-1622
US

V. Phone/Fax

Practice location:
  • Phone: 608-455-6070
  • Fax:
Mailing address:
  • Phone: 920-728-4768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10008-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: