Provider Demographics
NPI:1700969540
Name:HINTZ, JUSTINE MARIE
Entity type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:MARIE
Last Name:HINTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:HINTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:W307N6295 SHORE ACRES RD
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-8723
Mailing Address - Country:US
Mailing Address - Phone:262-367-7581
Mailing Address - Fax:
Practice Address - Street 1:16535 W BLUEMOUND RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5936
Practice Address - Country:US
Practice Address - Phone:262-542-3255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1330-125101YM0800X
WI1330101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health