Provider Demographics
NPI:1396801155
Name:HINZE, TRAVIS W (PHD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:W
Last Name:HINZE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 285
Mailing Address - Street 2:
Mailing Address - City:SIREN
Mailing Address - State:WI
Mailing Address - Zip Code:54872-0285
Mailing Address - Country:US
Mailing Address - Phone:800-994-4693
Mailing Address - Fax:715-349-5907
Practice Address - Street 1:329 S RIVER ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-9726
Practice Address - Country:US
Practice Address - Phone:800-994-4693
Practice Address - Fax:715-349-5907
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2125-057103T00000X
MNLP4441103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39135900Medicaid
WI39135900Medicaid