=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376544247
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA LEE ROTHWEILER PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3200 WESTHILL DR STE 101
-----------------------------------------------------
City | WAUSAU
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54401-4705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-847-2019
-----------------------------------------------------
Fax | 715-847-2669
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3200 WESTHILL DR STE 101
-----------------------------------------------------
City | WAUSAU
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54401-4705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-847-2019
-----------------------------------------------------
Fax | 715-847-2669
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number | 2022
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------