Provider Demographics
NPI:1740693993
Name:BEITLER, ANDREA DAWN (MA, PC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:DAWN
Last Name:BEITLER
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Gender:F
Credentials:MA, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2501 HANLEY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-8705
Mailing Address - Country:US
Mailing Address - Phone:715-381-1980
Mailing Address - Fax:715-381-1906
Practice Address - Street 1:2501 HANLEY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8705
Practice Address - Country:US
Practice Address - Phone:715-381-1980
Practice Address - Fax:715-381-1906
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI1935-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional