Provider Demographics
NPI:1063686921
Name:HENZE, LAURA A (CSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:A
Last Name:HENZE
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1177
Mailing Address - Street 2:926 SOUTH 8TH STREET
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54221-1177
Mailing Address - Country:US
Mailing Address - Phone:920-683-4230
Mailing Address - Fax:920-683-4908
Practice Address - Street 1:926 SOUTH 8TH STREET
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54221-1177
Practice Address - Country:US
Practice Address - Phone:920-683-4230
Practice Address - Fax:920-683-4908
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3324120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker