Provider Demographics
NPI:1184604308
Name:WIETHOFF, KRISTINE LEE (BS, CAC II)
Entity type:Individual
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First Name:KRISTINE
Middle Name:LEE
Last Name:WIETHOFF
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Gender:F
Credentials:BS, CAC II
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Other - First Name:
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Mailing Address - Street 1:1100 LUDINGTON ST
Mailing Address - Street 2:#401
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829
Mailing Address - Country:US
Mailing Address - Phone:906-789-1596
Mailing Address - Fax:906-789-2024
Practice Address - Street 1:1100 LUDINGTON ST
Practice Address - Street 2:#401
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829
Practice Address - Country:US
Practice Address - Phone:906-789-1596
Practice Address - Fax:906-789-2024
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)