Provider Demographics
NPI:1033485586
Name:GROTHE, ABBY JO (APSW)
Entity Type:Individual
Prefix:MISS
First Name:ABBY
Middle Name:JO
Last Name:GROTHE
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 WILLIAMSTOWNE # L10
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2322
Mailing Address - Country:US
Mailing Address - Phone:262-422-7932
Mailing Address - Fax:
Practice Address - Street 1:394 WILLIAMSTOWNE # L10
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2322
Practice Address - Country:US
Practice Address - Phone:262-422-7932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16653-130101YA0400X
WI128594-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)