BETH PROVOST

OCONOMOWOC, WI
NPI1194187757
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy1041C0700X Social Worker, Clinical
(Licence: WI  11953)
Additional Taxonomies104100000X Social Worker
(Licence: IA  115179)
171M00000X Case Manager/Care Coordinator
Enumeration Date2016-03-23
Last Update Date2024-11-10
Business Address
BETH PROVOST LCSW, LMSW
1060A LOWELL DR
OCONOMOWOC, WI 53066-4337
Phone number: 262-443-7917
Mailing Address
BETH PROVOST LCSW, LMSW
201 E 11TH ST
SPENCER, IA 51301-4436
Phone number: