Healthcare Provider Details

I. General information

NPI: 1366926396
Provider Name (Legal Business Name): BETH ANN WUERL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2018
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 CORPORATE CENTER DR STE 100
OCONOMOWOC WI
53066-4883
US

IV. Provider business mailing address

515 GLENWOOD DR
HARTLAND WI
53029-2703
US

V. Phone/Fax

Practice location:
  • Phone: 262-189-1191
  • Fax:
Mailing address:
  • Phone: 262-227-3386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8888-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: