Provider Demographics
NPI:1174042782
Name:POLZIN, AMY M (MA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:POLZIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:HELLER, PATTERSON, PATTERSON-BIBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 S DEWEY ST STE 208
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3781
Mailing Address - Country:US
Mailing Address - Phone:715-832-1678
Mailing Address - Fax:715-832-6680
Practice Address - Street 1:505 S DEWEY ST STE 208
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3781
Practice Address - Country:US
Practice Address - Phone:715-832-1678
Practice Address - Fax:715-832-6680
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3659-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional