Provider Demographics
NPI:1003188434
Name:MARTIN, CATHERINE COLETTE (BSW)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:COLETTE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:C
Other - Last Name:CUMBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:412 W KINNE ST
Mailing Address - Street 2:PO BOX 670
Mailing Address - City:ELLSWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:54011-9230
Mailing Address - Country:US
Mailing Address - Phone:715-273-6770
Mailing Address - Fax:715-273-6863
Practice Address - Street 1:412 W KINNE ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:WI
Practice Address - Zip Code:54011-9230
Practice Address - Country:US
Practice Address - Phone:715-273-6770
Practice Address - Fax:715-273-6863
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2157-120104100000X
MN8966104100000X
ND697104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker