Provider Demographics
NPI:1003247420
Name:WURTH, ROBERT DONALD
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DONALD
Last Name:WURTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-6214
Mailing Address - Country:US
Mailing Address - Phone:715-845-7175
Mailing Address - Fax:715-845-7142
Practice Address - Street 1:114 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-6214
Practice Address - Country:US
Practice Address - Phone:715-845-7175
Practice Address - Fax:715-845-7142
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1982-226104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker