Provider Demographics
NPI:1609335926
Name:WUETHRICH, CRYSTAL A
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:A
Last Name:WUETHRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11017 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:WI
Mailing Address - Zip Code:54441-9020
Mailing Address - Country:US
Mailing Address - Phone:715-387-1958
Mailing Address - Fax:715-387-1992
Practice Address - Street 1:11017 MAIN ST
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:WI
Practice Address - Zip Code:54441-9020
Practice Address - Country:US
Practice Address - Phone:715-305-5696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-16
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health