Healthcare Provider Details

I. General information

NPI: 1952569378
Provider Name (Legal Business Name): KATHRYN E MIZZI LMSW MSW ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W US-2 SUITE D
SAINT IGNACE MI
49781
US

IV. Provider business mailing address

PO BOX 303
SAINT IGNACE MI
49781
US

V. Phone/Fax

Practice location:
  • Phone: 906-643-7035
  • Fax: 906-643-7467
Mailing address:
  • Phone: 906-643-7035
  • Fax: 906-643-7467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801073772
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: