Provider Demographics
NPI:1982474284
Name:RETZLAFF, COURTNEY RYNAE
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:RYNAE
Last Name:RETZLAFF
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 1:2010 STEELE ST APT 206
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-8503
Mailing Address - Country:US
Mailing Address - Phone:920-763-5733
Mailing Address - Fax:
Practice Address - Street 1:1062 OAK FOREST DR STE 120
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-3501
Practice Address - Country:US
Practice Address - Phone:608-790-9481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health