Healthcare Provider Details

I. General information

NPI: 1477380962
Provider Name (Legal Business Name): KATHRYN LEE MAZUR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7665 US HIGHWAY 2
IRON RIVER WI
54847-4690
US

IV. Provider business mailing address

7665 US HIGHWAY 2
IRON RIVER WI
54847-4690
US

V. Phone/Fax

Practice location:
  • Phone: 715-372-5001
  • Fax: 715-372-5067
Mailing address:
  • Phone: 715-372-5001
  • Fax: 715-372-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12032-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: