Provider Demographics
NPI:1508738949
Name:MNICHOWICZ, CAROLYN R (MS CRC LPC-IT)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:R
Last Name:MNICHOWICZ
Suffix:
Gender:F
Credentials:MS CRC LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-0004
Mailing Address - Country:US
Mailing Address - Phone:715-563-0915
Mailing Address - Fax:
Practice Address - Street 1:N15427 BACHELORS AVE
Practice Address - Street 2:
Practice Address - City:THORP
Practice Address - State:WI
Practice Address - Zip Code:54771-7509
Practice Address - Country:US
Practice Address - Phone:715-563-0915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8381-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional