Provider Demographics
NPI:1629178892
Name:SCHULTZ, BRENDA LEE KETTNER (MSE, NCC, RADCI)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LEE KETTNER
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:MSE, NCC, RADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 PRENTICE ST N
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1162
Mailing Address - Country:US
Mailing Address - Phone:715-343-3347
Mailing Address - Fax:715-344-8127
Practice Address - Street 1:209 PRENTICE ST N
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1162
Practice Address - Country:US
Practice Address - Phone:715-343-3347
Practice Address - Fax:715-344-8127
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI204852 CERTIFICATION101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13594OtherWI CERT BOARD, RADCI