Healthcare Provider Details

I. General information

NPI: 1619254042
Provider Name (Legal Business Name): KATHRYN BARTZ MA, LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BARFIELD DR.
HASTINGS MI
49058-9018
US

IV. Provider business mailing address

500 BARFIELD DR.
HASTINGS MI
49058-9018
US

V. Phone/Fax

Practice location:
  • Phone: 269-948-8041
  • Fax: 269-948-9319
Mailing address:
  • Phone: 269-948-8041
  • Fax: 269-948-9319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number630102029
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301012029
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: