Healthcare Provider Details

I. General information

NPI: 1053508135
Provider Name (Legal Business Name): LYNN MARIE GENZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 E DIVISION ST
FOND DU LAC WI
54935-4560
US

IV. Provider business mailing address

1808 W BELTLINE HWY SSM HEALTH FDL REGIONAL CLINIC
MADISON WI
53713-2334
US

V. Phone/Fax

Practice location:
  • Phone: 920-926-4200
  • Fax: 920-926-8933
Mailing address:
  • Phone: 608-280-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3940-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: