Provider Demographics
NPI:1457816878
Name:HUETTL, ANGELA (LPC, CRC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HUETTL
Suffix:
Gender:F
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242031 COUNTY ROAD Y
Mailing Address - Street 2:
Mailing Address - City:ANIWA
Mailing Address - State:WI
Mailing Address - Zip Code:54408-5047
Mailing Address - Country:US
Mailing Address - Phone:715-203-7019
Mailing Address - Fax:
Practice Address - Street 1:115 N 6TH ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-5519
Practice Address - Country:US
Practice Address - Phone:715-849-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7550-125101YP2500X
WI3655-226101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional