Individual
JOHN ROHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, MSW
Contact information
Practice address
630 S 36TH AVE, WAUSAU, WI 54401-3930
(715) 842-9500
Mailing address
630 S 36TH AVE, WAUSAU, WI 54401-3930
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
134443-121
WI
1041C0700X
Clinical Social Worker
Primary
12148-123
WI
Other
Enumeration date
10/19/2023
Last updated
01/30/2025
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