Individual
COURTNEY BALTHAZOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SAC-IT
Contact information
Practice address
3 RIVERVIEW DR, MANITOWOC, WI 54220-3767
(920) 663-1035
(920) 215-4918
Mailing address
1111 S 9TH ST APT B, MANITOWOC, WI 54220-5342
(920) 344-7602
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20064130
WI
Other
Enumeration date
10/18/2022
Last updated
10/18/2022
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