Healthcare Provider Details

I. General information

NPI: 1609149145
Provider Name (Legal Business Name): KATHRYN LOUISE BERTZ LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 W 9TH ST
DULUTH MN
55807-1563
US

IV. Provider business mailing address

4000 W 9TH ST
DULUTH MN
55807-1563
US

V. Phone/Fax

Practice location:
  • Phone: 218-628-0237
  • Fax: 218-628-1347
Mailing address:
  • Phone: 218-628-0237
  • Fax: 218-628-1347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC00400
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: