Provider Demographics
NPI:1699795633
Name:PATZ-HUTWAGNER, WENDY SUE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:SUE
Last Name:PATZ-HUTWAGNER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 BOLAND RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-4629
Mailing Address - Country:US
Mailing Address - Phone:920-497-3126
Mailing Address - Fax:920-497-3176
Practice Address - Street 1:141 SIEGLER ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-2635
Practice Address - Country:US
Practice Address - Phone:920-497-3126
Practice Address - Fax:920-497-3176
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7283-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical