Provider Demographics
NPI:1144236084
Name:SCHUTZ, SUSAN MARIE (LICSW CEAP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:SCHUTZ
Suffix:
Gender:F
Credentials:LICSW CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927A SOUTH 8TH STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220
Mailing Address - Country:US
Mailing Address - Phone:920-684-6644
Mailing Address - Fax:920-684-1110
Practice Address - Street 1:927A SOUTH 8TH STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220
Practice Address - Country:US
Practice Address - Phone:920-684-6644
Practice Address - Fax:920-684-1110
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2901231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00038265Medicare ID - Type Unspecified