Provider Demographics
NPI:1942278304
Name:WHITTEMORE, BETH S (MSW)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:S
Last Name:WHITTEMORE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 ROYAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1535
Mailing Address - Country:US
Mailing Address - Phone:608-661-2829
Mailing Address - Fax:608-661-0907
Practice Address - Street 1:2829 ROYAL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-1535
Practice Address - Country:US
Practice Address - Phone:608-661-2829
Practice Address - Fax:608-661-0907
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI711101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39263600Medicaid
WI39263600Medicaid