Provider Demographics
NPI:1053460956
Name:WILDER-STIEBER, BETH D (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:D
Last Name:WILDER-STIEBER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:D
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:875 BRISTERS HILL RD
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-8345
Mailing Address - Country:US
Mailing Address - Phone:715-842-4484
Mailing Address - Fax:
Practice Address - Street 1:903 2ND ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4705
Practice Address - Country:US
Practice Address - Phone:715-842-3346
Practice Address - Fax:715-842-3344
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI776-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39218300Medicaid