Provider Demographics
NPI:1578955696
Name:PRITZL, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:PRITZL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 HALL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-1655
Mailing Address - Country:US
Mailing Address - Phone:715-732-7692
Mailing Address - Fax:715-732-7766
Practice Address - Street 1:2500 HALL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1655
Practice Address - Country:US
Practice Address - Phone:715-732-7692
Practice Address - Fax:715-732-7766
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker