Individual
MARIE ANNETTE BASTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICENSED CLINICAL SO
Contact information
Practice address
LAC COURTE OREILLES COMMUNITY HEALTH CENTER, 13380 W TREPANIA ROAD, HAYWARD, WI 54843
(715) 638-5100
Mailing address
13380 W TREPANIA ROAD, HAYWARD, WI 54843
(715) 497-0790
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
127176
WI
1041C0700X
Clinical Social Worker
Primary
7686-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43716300
—
WI
Enumeration date
05/16/2007
Last updated
03/13/2022
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