Individual provider · Type 1 NPI
Maribeth Rose Dettlaff, MSW, LCSW, CADC
Addiction (Substance Use Disorder) Counselor · Waukesha, WI
NPI number
1629132840
Active
Practice location
500 Riverview Ave Ste 2
Waukesha, WI 53188-3632
Mailing address
W168S7024 Parkland Dr
Muskego, WI 53150-9441
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Addiction (Substance Use Disorder) Counselor Primary | 101YA0400X | 12548 (WI) |
| Clinical Social Worker | 1041C0700X | 521-123 (WI) |
Addiction (Substance Use Disorder) Counselor: Definition to come...
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About NPI 1629132840
Maribeth Rose Dettlaff, MSW, LCSW, CADC's National Provider Identifier is 1629132840, issued on Dec 21, 2006. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Waukesha, WI. The record was last updated on Sep 11, 2025.