Healthcare Provider Details

I. General information

NPI: 1831017029
Provider Name (Legal Business Name): HEATHER LEE SCHULTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 OLD GREEN LAKE RD
PRINCETON WI
54968-8667
US

IV. Provider business mailing address

W5970 HOLMES RD
PRINCETON WI
54968-8452
US

V. Phone/Fax

Practice location:
  • Phone: 608-386-0969
  • Fax: 920-295-6571
Mailing address:
  • Phone: 608-386-0969
  • Fax: 920-295-6571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3590001217
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: