Provider Demographics
NPI:1306270566
Name:LARSON SCHLITZ, LINDA MARIE (MS)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:LARSON SCHLITZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:MARIE
Other - Last Name:PARISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-5305
Mailing Address - Country:US
Mailing Address - Phone:715-212-2339
Mailing Address - Fax:
Practice Address - Street 1:701 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5305
Practice Address - Country:US
Practice Address - Phone:715-212-2339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI679-122101YM0800X
WI1854-125171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator