Individual
BETH PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LMSW
Contact information
Practice address
1060A LOWELL DR, OCONOMOWOC, WI 53066-4337
(262) 443-7917
Mailing address
201 E 11TH ST, SPENCER, IA 51301-4436
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
115179
IA
104100000X
Social Worker
Primary
12062-123
WI
1041C0700X
Clinical Social Worker
11953-123
WI
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
03/23/2016
Last updated
12/10/2024
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