Provider Demographics
NPI:1447423421
Name:PEETZ, KATHY B (MS)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:B
Last Name:PEETZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:HINICH
Other - Last Name:PEETZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:3801 SPRING STREET
Mailing Address - Street 2:ALL SAINTS HEALTHCARE
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405
Mailing Address - Country:US
Mailing Address - Phone:262-687-2722
Mailing Address - Fax:262-687-2499
Practice Address - Street 1:1320 WISCONSIN AVE
Practice Address - Street 2:MENTAL HEALTH AND ADDICTION CARE
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1978
Practice Address - Country:US
Practice Address - Phone:262-687-2722
Practice Address - Fax:262-687-2499
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI365-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health