Statz, Shelly Rose

Statz, Shelly Rose is an individual health care provider with primary practice located at 2910 Enloe St , Hudson WI 54016-4538. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Statz, Shelly Rose can be contacted via phone (715) 381-5437.

Contact Information

Primary practice address
2910 Enloe St Hudson WI 54016-4538
Phone: (715) 381-5437
Fax: (715) 381-5438
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 7021-123 Wisconsin

Profile Details

NPI number 1235121260
LBN Legal business name Statz, Shelly Rose
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 16th, 2005
Last updated Jun 6th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235121260 NPPES
Other 114321498 CAQH

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