Provider Demographics
NPI:1558190363
Name:RHOADS-ETTEN, MARLA D (CSAC)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:D
Last Name:RHOADS-ETTEN
Suffix:
Gender:U
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N5308 LOCUST RD
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-6035
Mailing Address - Country:US
Mailing Address - Phone:715-853-3829
Mailing Address - Fax:
Practice Address - Street 1:N5308 LOCUST RD
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-6035
Practice Address - Country:US
Practice Address - Phone:715-853-3829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1891-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)