Provider Demographics
NPI:1831614049
Name:BERTHELSEN, JOANNE M (MSW, LCSW, SACIT)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:M
Last Name:BERTHELSEN
Suffix:
Gender:F
Credentials:MSW, LCSW, SACIT
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:M
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW, SACIT
Mailing Address - Street 1:3011 WIND SONG LN
Mailing Address - Street 2:
Mailing Address - City:BAILEYS HARBOR
Mailing Address - State:WI
Mailing Address - Zip Code:54202-9164
Mailing Address - Country:US
Mailing Address - Phone:262-235-2350
Mailing Address - Fax:262-804-8132
Practice Address - Street 1:3011 WIND SONG LN
Practice Address - Street 2:
Practice Address - City:BAILEYS HARBOR
Practice Address - State:WI
Practice Address - Zip Code:54202-9164
Practice Address - Country:US
Practice Address - Phone:262-235-2350
Practice Address - Fax:262-804-8132
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18294-130101YA0400X
WI8705-123101YM0800X, 1041C0700X
FLSW188761041C0700X
MI68011124081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100071305Medicaid