Provider Demographics
NPI:1639145394
Name:ATHORP-KRECH, ANN L (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:L
Last Name:ATHORP-KRECH
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 1:604 N 44TH ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-3430
Mailing Address - Country:US
Mailing Address - Phone:920-562-8527
Mailing Address - Fax:
Practice Address - Street 1:50 S MADISON AVE STE 3
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-2742
Practice Address - Country:US
Practice Address - Phone:920-743-4428
Practice Address - Fax:920-743-4681
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2516-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39750900Medicaid
WI0003Medicare ID - Type Unspecified