Healthcare Provider Details

I. General information

NPI: 1508676313
Provider Name (Legal Business Name): NICOLE MARIE WOITULA MSW, APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE MARIE TOETZ

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 N 6TH ST
WAUSAU WI
54403-3438
US

IV. Provider business mailing address

1392 HIGHWAY 66 W
STEVENS POINT WI
54481-9053
US

V. Phone/Fax

Practice location:
  • Phone: 715-393-9458
  • Fax:
Mailing address:
  • Phone: 920-312-2946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number135532-121
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: