Provider Demographics
NPI:1336388388
Name:PLOETZ, CORIENE MARIE (MS, NCC)
Entity Type:Individual
Prefix:MRS
First Name:CORIENE
Middle Name:MARIE
Last Name:PLOETZ
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:MISS
Other - First Name:CORIENE
Other - Middle Name:MARIE
Other - Last Name:ROBBINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:612 N RANDALL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-1958
Mailing Address - Country:US
Mailing Address - Phone:608-752-7660
Mailing Address - Fax:608-752-9788
Practice Address - Street 1:612 N RANDALL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-1958
Practice Address - Country:US
Practice Address - Phone:608-752-7660
Practice Address - Fax:608-752-9788
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health