Provider Demographics
NPI:1790403087
Name:MILETICH, BETHANY K (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:K
Last Name:MILETICH
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:K
Other - Last Name:MAHLKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 EAST 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805
Mailing Address - Country:US
Mailing Address - Phone:218-728-4491
Mailing Address - Fax:218-302-8698
Practice Address - Street 1:1401 EAST 1ST STREET
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805
Practice Address - Country:US
Practice Address - Phone:218-728-4491
Practice Address - Fax:218-302-8698
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN284011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical