Marilyn Elizabeth Bohatkiewicz, PHD
Individual provider Active NPI Clinical Psychologist · De Pere, WI
NPI 1992884159 · NPPES record last updated Feb 24, 2014
Key facts
- NPI
- 1992884159
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 1180057 (WI)
- Practice address
- 2200 Dickinson Rd Unit 4
Suite B
De Pere, WI 54115-4056 - Phone
- (920) 347-3500
- Fax
- (920) 347-3501
- NPI assigned
- Nov 6, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1180057 | WI | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bonnie M Lee & Associates | Past | Accepting new patients | |
| Marriage & Family Therapy Center | Past | Accepting new patients | |
| Mental Health Partners, SC | Past | Accepting new patients | |
| George Soncrant D/B/a Behavioral Services | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1180057 | WI | Yes |
Addresses
Primary practice location
2200 Dickinson Rd Unit 4
Suite B
De Pere, WI 54115-4056
Mailing address
2200 Dickinson Rd Unit 4
Suite B
De Pere, WI 54115-4056
Phone (920) 347-3500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39040500 | Medicaid | WI |
Other providers in De Pere, WI
- Katie E Bischoff
- Joelle Rae Bitters
- Meghan Bittner
- Jill Blaha
- Bobbie Jo Lee Bleser
- Kenneth William Bond
- Bonnie M Lee & Associates
- Sarah Books
- Tiffany Lynn Born
- Ryan Patrick Bourdelais
All providers in De Pere, WI · Clinical Psychologist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.