Provider Demographics
NPI:1114767902
Name:RETZLAFF, GARETT
Entity type:Individual
Prefix:
First Name:GARETT
Middle Name:
Last Name:RETZLAFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 S BARSTOW ST APT 419
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4896
Mailing Address - Country:US
Mailing Address - Phone:715-828-9224
Mailing Address - Fax:
Practice Address - Street 1:2005 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4455
Practice Address - Country:US
Practice Address - Phone:715-832-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health