Healthcare Provider Details

I. General information

NPI: 1508770660
Provider Name (Legal Business Name): COURTNEY ZAWISTOWSKI LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 E CAPITOL DR UNIT 11105
MILWAUKEE WI
53211-4602
US

IV. Provider business mailing address

1620 E CAPITOL DR UNIT 11105
MILWAUKEE WI
53211-4602
US

V. Phone/Fax

Practice location:
  • Phone: 262-236-7102
  • Fax: 262-384-3749
Mailing address:
  • Phone: 262-236-7102
  • Fax: 262-384-3749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number9343226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: