Provider Demographics
NPI:1932205358
Name:WERTH, ANTHONY FRANCIS JR (MS)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:FRANCIS
Last Name:WERTH
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FALLS RD STE 326
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-2612
Mailing Address - Country:US
Mailing Address - Phone:262-421-8980
Mailing Address - Fax:262-421-8971
Practice Address - Street 1:101 FALLS RD STE 326
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-2612
Practice Address - Country:US
Practice Address - Phone:262-421-8980
Practice Address - Fax:262-421-8971
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2700-125101YP2500X
WI12125101YA0400X
WI2700125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39779300Medicaid