Dettlaff, Maribeth Rose

Dettlaff, Maribeth Rose is an sole proprietor health care provider with primary practice located at 500 Riverview Ave Ste 2 , Waukesha WI 53188-3632. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is her primary health care specialty. Dettlaff, Maribeth Rose can be contacted via phone (262) 548-7399.

Contact Information

Primary practice address
500 Riverview Ave Ste 2 Waukesha WI 53188-3632
Phone: (262) 548-7399
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 12548 Wisconsin
Behavioral Health & Social Service Providers / Clinical 1041C0700X 521-123 Wisconsin

Profile Details

NPI number 1629132840
LBN Legal business name Dettlaff, Maribeth Rose
Credentials MSW, LCSW, CADC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 21st, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629132840 NPPES
Wisconsin Other 39572300 T-19 PROVIDER NUMBER

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