MARIBETH ROSE DETTLAFF (NPI# 1629132840) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629132840 |
| Entity Type | Individual |
| Full Name | MARIBETH ROSE DETTLAFF |
| Credential | MSW, LCSW, CADC |
| Practice Address |
500 Riverview Ave Ste 2 Waukesha WI 53188-3632 |
| Mailing Address |
W168s7024 Parkland Dr Muskego WI 53150-9441 |
| Practice Telephone | 2625487399 |
| Mailing Telephone | 4144220708 |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
12548 | WI | Behavioral Health & Social Service Providers |
| X | 1041C0700X |
Social Worker Specialization: Clinical |
521-123 | WI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | T-19 PROVIDER NUMBER | 39572300 | 01 |
| Street Address |
500 RIVERVIEW AVE STE 2 |
| City | WAUKESHA |
| State | WI |
| Zip Code | 53188-3632 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336787126 | Nicole Lee Berg-johnson | Nurse Practitioner | 820 Crestwood Dr., Waukesha, WI 53188 | 2019-12-12 |
| 1013475706 | Rachel Mueller | Occupational Therapist | 29667 Summit Ave, S11, Waukesha, WI 53188 | 2019-03-12 |
| 1861962649 | Emily Elizabeth Seefeld | Occupational Therapy Assistant | 29667 Summit Ave S11, Waukesha, WI 53188 | 2018-12-05 |
| 1003393307 | Ashley Susan Callahan | Dental Hygienist | 711 W. Moreland Blvd., Suite 204, Waukesha, WI 53188 | 2018-07-19 |
| 1245741321 | Melissa Weir | Case Manager/Care Coordinator | 514 Riverview Avenue, Waukesha, WI 53188 | 2017-10-17 |
| 1093233629 | Patricia Marie Sombrio | Dental Hygienist | 711 Moreland Blvd 204, Waukesha, WI 53188 | 2017-09-04 |
| 1134660244 | Bdg of Wisconsin, Inc. | Behavioral Analyst | N19w2309 Riverwood Drive, Suite 350 Pmb 314, Waukesha, WI 53188 | 2017-03-09 |
| 1255888731 | Lynne Sarah Alva | Dental Hygienist | 711 Moreland Blvd, Suite 204, Waukesha, WI 53188 | 2016-09-01 |
| 1881069730 | Michelle Koch | Occupational Therapist | 29667 Summit Ave. S11, Waukesha, WI 53188 | 2015-12-03 |
| 1952711012 | Rhonda Schroeder | Dental Hygienist | W286 N991 Shepherds Way, Waukesha, WI 53188 | 2014-04-29 |
| Find all providers in zip 53188 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467917609 | Choice 2 Change Therapy, Inc. | Counselor | 217 Wisconsin Ave Ste 114, Waukesha, WI 53186-4946 | 2019-02-01 |
| 1851864029 | Daniel Chadwick | Counselor | 741 N Grand Ave Ste 204, Waukesha, WI 53186-4841 | 2019-01-09 |
| 1376021782 | Jasen Alan Eberhardt | Counselor | 223 Wisconsin Ave Ste B, Waukesha, WI 53186-4968 | 2018-07-30 |
| 1952601833 | Heidi J Rubio | Counselor | 210 Nw Barstow St, Suite 110, Waukesha, WI 53188 | 2010-10-26 |
| 1477793180 | Sarah M Smith | Counselor | W231n1440 Corporate Ct # 310, Waukesha, WI 53186-1303 | 2009-02-21 |
| 1952577488 | Patricia Rose Gutierrez | Counselor | 147 Randall St, Waukesha, WI 53188-3528 | 2008-05-05 |
| 1902091135 | Tamara L Erickson | Counselor | 2314 Grandview Blvd, Suites 301 & 110, Waukesha, WI 53188-1675 | 2007-09-11 |
| 1275734105 | Denise Louise Drum | Counselor | 407 Pilot Ct Ste 400, Waukesha, WI 53188-2466 | 2007-05-29 |
| 1124182126 | David Poehlmann | Counselor | 2422 N Grandview Blvd, Suite 501, Waukesha, WI 53188-6105 | 2006-12-21 |
| 1013078518 | Daniel E Hermsen | Counselor | W231 N1440 Corporate Court, Suite 310, Waukesha, WI 53186-1301 | 2006-12-12 |
| Find all providers in WAUKESHA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.