Healthcare Provider Details

I. General information

NPI: 1689994790
Provider Name (Legal Business Name): ELIZABETH E SCHULTZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 NIAGARA AVE
SHEBOYGAN WI
53081-4128
US

IV. Provider business mailing address

1609 S 13TH ST
SHEBOYGAN WI
53081-5251
US

V. Phone/Fax

Practice location:
  • Phone: 920-451-8667
  • Fax: 920-451-8799
Mailing address:
  • Phone: 920-207-6297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: