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General NPI Number Information
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NPI Number | 1407078835
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Entity Type | Individual
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Provider Name | SANDRA LYNN MUETZEL L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | W247S10395 CENTER DR
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City | MUKWONAGO
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State | WI
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Zip | 53149-9166
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Country | US
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Telephone | 262-662-5900
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Fax | 262-662-5688
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Provider Business Mailing Address
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Address Line | 826 CHELSEA DR
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City | ELKHORN
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State | WI
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Zip | 53121-1198
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Country | US
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Telephone | 262-743-1760
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Fax | 262-662-5688
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6876-123
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License Number State | WI
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