Healthcare Provider Details

I. General information

NPI: 1174159586
Provider Name (Legal Business Name): ANNA-LIISA MARIE KAUTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 CLEVELAND AVE STE 114
ISHPEMING MI
49849-1842
US

IV. Provider business mailing address

308 CLEVELAND AVE STE 114
ISHPEMING MI
49849-1842
US

V. Phone/Fax

Practice location:
  • Phone: 906-631-7507
  • Fax:
Mailing address:
  • Phone: 906-631-7507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024833
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: