Provider Demographics
NPI:1043377229
Name:HOLTZ, JEAN M (RD, MSE, LPC)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:M
Last Name:HOLTZ
Suffix:
Gender:F
Credentials:RD, MSE, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 STROEBE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-8758
Mailing Address - Country:US
Mailing Address - Phone:920-830-4002
Mailing Address - Fax:
Practice Address - Street 1:2430 STROEBE ISLAND DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-8758
Practice Address - Country:US
Practice Address - Phone:920-830-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3407-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health