Provider Demographics
NPI:1487761581
Name:STOHL, BARBARA HYDE (LCSW,LMFT)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:HYDE
Last Name:STOHL
Suffix:
Gender:F
Credentials:LCSW,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TWO RIVERS
Mailing Address - State:WI
Mailing Address - Zip Code:54241-3229
Mailing Address - Country:US
Mailing Address - Phone:920-657-1784
Mailing Address - Fax:920-657-1784
Practice Address - Street 1:115 E WALDO BLVD
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2907
Practice Address - Country:US
Practice Address - Phone:920-682-1131
Practice Address - Fax:920-682-5087
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2484-1231041C0700X
WI611-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40941000Medicaid
WI40941000Medicaid