Colleen Etzbach, RHD, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CC03123 Issued in MN

Practice address

145 2ND St W
Wabasha, MN 55981-1245

Phone

(715) 279-8591

NPI assigned

Jul 16, 2017

Last updated

Nov 22, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cosan Leighis LLC

  • Professional Counselor
  • Wabasha, MN
  • NPI 1457066284
  NPD Authorized official
• Beacon Mental Health Resources LLC

  • Marriage & Family Therapist
  • Menomonie, WI
  • NPI 1407379787
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1500163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732233600000",
    "number": "1326560889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 2ND ST W",
            "city": "WABASHA",
            "state": "MN",
            "postal_code": "559811245",
            "telephone_number": "715-279-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 2ND ST W",
            "city": "WABASHA",
            "state": "MN",
            "postal_code": "559811245",
            "telephone_number": "715-279-8591"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1421 Broadway St N Ste 114B",
            "address_purpose": "LOCATION",
            "city": "Menomonie",
            "state": "WI",
            "postal_code": "547514728",
            "country_code": "US",
            "telephone_number": "715-308-5742",
            "fax_number": "888-972-4831",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETZBACH",
        "first_name": "COLLEEN",
        "name_prefix": "Dr.",
        "credential": "RHD, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-16",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "5537",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC03123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crossroads Behavioral Health, P.L.C.
• Jeffrey Darling, PT
• Thomas Edward Dudley, M.D.
• Scott Holt Durand, DDS
• Eagle Valley Chiropractic LLC
• Zachary Christopher Evans
• Mary Lou Fellows
• Carol Ann Groth
• Kinsley Sara Hackman, SLP
• Marc J. Hampl, PA-C

• Professional Counselor in Wabasha, MN
• Providers in Wabasha, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.