Healthcare Provider Details

I. General information

NPI: 1841322666
Provider Name (Legal Business Name): WENDY MARIE KOTZIAN-GORDON LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 S RIPLEY BLVD
ALPENA MI
49707-3406
US

IV. Provider business mailing address

PO BOX 342
HILLMAN MI
49746-0342
US

V. Phone/Fax

Practice location:
  • Phone: 989-356-6385
  • Fax: 989-356-4909
Mailing address:
  • Phone: 989-356-6385
  • Fax: 989-356-4909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401009198
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: