Healthcare Provider Details

I. General information

NPI: 1861611980
Provider Name (Legal Business Name): GRETCHEN LEE HULETZ MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS GRETCHEN LEE ZICH

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6809 122ND AVE
KENOSHA WI
53142-7335
US

IV. Provider business mailing address

9000 W WISCONSIN AVE # MS 958
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 262-652-5522
  • Fax: 262-652-7228
Mailing address:
  • Phone: 414-266-7615
  • Fax: 414-266-6238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3801-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: