Provider Demographics
NPI:1184900607
Name:PUTZY, SHAUNA (LPC)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:PUTZY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:
Other - Last Name:HILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BEHAVIOR ANALYST
Mailing Address - Street 1:1324 W CLAIREMONT AVE
Mailing Address - Street 2:STE 6
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701
Mailing Address - Country:US
Mailing Address - Phone:715-895-7115
Mailing Address - Fax:
Practice Address - Street 1:1324 W CLAIREMONT AVE
Practice Address - Street 2:STE 6
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701
Practice Address - Country:US
Practice Address - Phone:715-895-7115
Practice Address - Fax:715-836-0065
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
WI5709-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10049043Medicaid