Provider Demographics
NPI:1699728329
Name:CROTHERS, MARIE K (PHD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:K
Last Name:CROTHERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4455
Mailing Address - Country:US
Mailing Address - Phone:715-832-5454
Mailing Address - Fax:715-832-2991
Practice Address - Street 1:2005 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4455
Practice Address - Country:US
Practice Address - Phone:715-832-5454
Practice Address - Fax:715-832-2991
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2393057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6150399OtherMEDICAL UBH UHC
WI68434OtherSECURITY HEALTH PLAN
MN99FO6CROtherBCBS MN
WI43573200Medicaid
MN637871026353OtherPREFERRED ONE
MNHP39199OtherHEALTH PARTNERS
MN99FO6CROtherBCBS MN