Healthcare Provider Details

I. General information

NPI: 1356275903
Provider Name (Legal Business Name): EMMA POLZIN MFT-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 DONOFRIO DR STE 206
MADISON WI
53719-2839
US

IV. Provider business mailing address

7113 BELLE FONTAINE BLVD UNIT 201
MIDDLETON WI
53562-1078
US

V. Phone/Fax

Practice location:
  • Phone: 608-424-9100
  • Fax:
Mailing address:
  • Phone: 608-598-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1239228
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: