Provider Demographics
NPI:1821199514
Name:PUETZ, NANCY (AUD CCCA)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:PUETZ
Suffix:
Gender:F
Credentials:AUD CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5508 D J LN
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-1578
Mailing Address - Country:US
Mailing Address - Phone:715-212-4699
Mailing Address - Fax:715-261-2223
Practice Address - Street 1:5508 D J LN
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-1578
Practice Address - Country:US
Practice Address - Phone:715-212-4699
Practice Address - Fax:715-261-2223
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI216231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41129300Medicaid
WI008839295Medicare ID - Type Unspecified
WI41129300Medicaid