Provider Demographics
NPI:1184459943
Name:KAATZ, SHERIDAN
Entity type:Individual
Prefix:
First Name:SHERIDAN
Middle Name:
Last Name:KAATZ
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 1:1062 OAK FOREST DR STE 120
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-3501
Mailing Address - Country:US
Mailing Address - Phone:608-790-9481
Mailing Address - Fax:
Practice Address - Street 1:1062 OAK FOREST DR STE 120
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-3501
Practice Address - Country:US
Practice Address - Phone:608-790-9481
Practice Address - Fax:608-790-9480
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1123-228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health