Provider Demographics
NPI:1457962938
Name:LUTZEN, EMILY J
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:LUTZEN
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 1:8317 MANSION HILL AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-6101
Mailing Address - Country:US
Mailing Address - Phone:715-379-1309
Mailing Address - Fax:
Practice Address - Street 1:2125 HEIGHTS DR STE 2F
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6146
Practice Address - Country:US
Practice Address - Phone:715-832-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI123-99511041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical