Provider Demographics
NPI:1437644259
Name:HART, BETHANY MARIE (MSW, APSW)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:MARIE
Last Name:HART
Suffix:
Gender:F
Credentials:MSW, APSW
Other - Prefix:MS
Other - First Name:BETHANY
Other - Middle Name:MARIE
Other - Last Name:FRITSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:571 BRAUND ST
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8556
Mailing Address - Country:US
Mailing Address - Phone:608-785-7000
Mailing Address - Fax:608-785-7477
Practice Address - Street 1:571 BRAUND ST
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8556
Practice Address - Country:US
Practice Address - Phone:608-785-7000
Practice Address - Fax:608-785-7477
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131100-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI131100-121OtherAPSW