Individual
MS. SHELLY ROSE STATZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2910 ENLOE ST, HUDSON, WI 54016-4538
(715) 381-5437
(715) 381-5438
Mailing address
2925 MONDOVI RD, EAU CLAIRE, WI 54701-6141
(715) 832-0238
(715) 832-0771
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7021-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
114321498
CAQH
—
Enumeration date
08/16/2005
Last updated
06/06/2016
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