Provider Demographics
NPI:1184389645
Name:ROTHE, KELSEY (MFT-IT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:ROTHE
Suffix:
Gender:F
Credentials:MFT-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15735 W US HIGHWAY 63
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-6475
Mailing Address - Country:US
Mailing Address - Phone:715-634-2541
Mailing Address - Fax:715-934-5554
Practice Address - Street 1:300 MAIN ST W
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1639
Practice Address - Country:US
Practice Address - Phone:715-685-2200
Practice Address - Fax:715-934-5554
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist