Individual
SHELLY LYNN DUTCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSAC, ICS
Contact information
Practice address
1334 APPLEGATE RD, SUITE 101, MADISON, WI 53713-3184
(608) 221-1500
(608) 221-1515
Mailing address
1334 APPLEGATE RD, SUITE 101, MADISON, WI 53713-3184
(608) 221-1500
(608) 221-1515
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1047-132
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1047-132
CLINICAL SUB. ABUSE COUN
WI
01
—
12230-134
INTERMEDIATE CLINICAL SUP
WI
Enumeration date
06/26/2007
Last updated
07/08/2007
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