Healthcare Provider Details

I. General information

NPI: 1346993995
Provider Name (Legal Business Name): KATHERINE LOUISE DYZE LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 GENOA BUSINESS PARK DR STE 100
BRIGHTON MI
48114-5328
US

IV. Provider business mailing address

1100 TORREY RD STE 100
FENTON MI
48430-3327
US

V. Phone/Fax

Practice location:
  • Phone: 810-449-7180
  • Fax: 248-692-4936
Mailing address:
  • Phone: 810-494-7180
  • Fax: 248-692-4936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851114215
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: