Provider Demographics
NPI:1699196923
Name:SCHULTZ, EMILY JO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:JO
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:JO
Other - Last Name:ZILLMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:N6594 DEXTER RD
Mailing Address - Street 2:
Mailing Address - City:HORICON
Mailing Address - State:WI
Mailing Address - Zip Code:53032-1748
Mailing Address - Country:US
Mailing Address - Phone:920-344-4489
Mailing Address - Fax:920-643-2003
Practice Address - Street 1:N6594 DEXTER RD
Practice Address - Street 2:
Practice Address - City:HORICON
Practice Address - State:WI
Practice Address - Zip Code:53032-1748
Practice Address - Country:US
Practice Address - Phone:920-344-4489
Practice Address - Fax:920-643-2003
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3320-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical