Provider Demographics
NPI:1861611980
Name:HULETZ, GRETCHEN LEE (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:LEE
Last Name:HULETZ
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MISS
Other - First Name:GRETCHEN
Other - Middle Name:LEE
Other - Last Name:ZICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE # MS 958
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-7615
Mailing Address - Fax:414-266-6238
Practice Address - Street 1:6809 122ND AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7335
Practice Address - Country:US
Practice Address - Phone:262-652-5522
Practice Address - Fax:262-652-7228
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3801-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional