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General NPI Number Information
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NPI Number | 1609335926
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Entity Type | Individual
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Provider Name | CRYSTAL A WUETHRICH
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Gender | Female
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Dates
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Enumeration Date | 03/16/2019
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 390 RED CEDAR ST STE 108
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City | MENOMONIE
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State | WI
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Zip | 54751-2265
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Country | US
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Telephone | 612-217-0584
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Fax |
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Provider Business Mailing Address
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Address Line | 11017 MAIN ST
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City | HEWITT
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State | WI
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Zip | 54441-9020
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Country | US
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Telephone | 715-387-1958
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Fax | 715-387-1992
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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