Provider Demographics
NPI:1376544247
Name:ROTHWEILER, BARBARA LEE (PHD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:LEE
Last Name:ROTHWEILER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 WESTHILL DR
Mailing Address - Street 2:STE 101
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4705
Mailing Address - Country:US
Mailing Address - Phone:715-847-2019
Mailing Address - Fax:715-847-2669
Practice Address - Street 1:3200 WESTHILL DR
Practice Address - Street 2:STE 101
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4705
Practice Address - Country:US
Practice Address - Phone:715-847-2019
Practice Address - Fax:715-847-2669
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2022103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP12027309OtherWPPN MULTIPLAN
WI32757000OtherWISCONCARE
WA0186440OtherDEPT LABOR & INDUST
WI49480OtherSECURITY HEALTH PLAN
WI39119400Medicaid
TN391633557 0002OtherCISNA TN
WIP12027309OtherWPPN MULTIPLAN