1144236084 NPI number — MRS. SUSAN MARIE SCHUTZ LICSW CEAP

Table of content: MRS. SUSAN MARIE SCHUTZ LICSW CEAP (NPI 1144236084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144236084 NPI number — MRS. SUSAN MARIE SCHUTZ LICSW CEAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHUTZ
Provider First Name:
SUSAN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW CEAP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144236084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
927A SOUTH 8TH STREET
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
MANITOWOC
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-684-6644
Provider Business Mailing Address Fax Number:
920-684-1110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
927A SOUTH 8TH STREET
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
MANITOWOC
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-684-6644
Provider Business Practice Location Address Fax Number:
920-684-1110
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  290123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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