Provider Demographics
NPI:1659719680
Name:SCHULTZ, KATHERIN ALMIRA (MS, LMFT, CSAC)
Entity Type:Individual
Prefix:MS
First Name:KATHERIN
Middle Name:ALMIRA
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:MS, LMFT, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 ANNEX RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-9655
Mailing Address - Country:US
Mailing Address - Phone:920-674-7259
Mailing Address - Fax:920-674-6133
Practice Address - Street 1:1541 ANNEX RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-9655
Practice Address - Country:US
Practice Address - Phone:920-674-7259
Practice Address - Fax:920-674-6133
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16147-132101YA0400X
WI1006-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)