Provider Demographics
NPI:1386670875
Name:BELZER, STEPHANIE P (APSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:P
Last Name:BELZER
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:P
Other - Last Name:SIMDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 MCMILLEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-1263
Mailing Address - Country:US
Mailing Address - Phone:920-563-9542
Mailing Address - Fax:920-568-6047
Practice Address - Street 1:509 MCMILLEN ST
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-1263
Practice Address - Country:US
Practice Address - Phone:920-563-9542
Practice Address - Fax:920-568-6047
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2196-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI007030345Medicare PIN