Provider Demographics
NPI:1790545275
Name:FOLTZ, HANNAH MARIE
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:MARIE
Last Name:FOLTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7957 W WIND LAKE RD STE E
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-2234
Mailing Address - Country:US
Mailing Address - Phone:608-561-8656
Mailing Address - Fax:
Practice Address - Street 1:7957 W WIND LAKE RD STE E
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-2234
Practice Address - Country:US
Practice Address - Phone:608-561-8656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1093496283OtherBEHAVIORAL HEALTH AND SOCIAL SERVICE PROVIDER