Provider Demographics
NPI:1598158230
Name:RAMTHUN, CARLY RAE KAZMERZAK (MA, MT-BC, CTP)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:RAE KAZMERZAK
Last Name:RAMTHUN
Suffix:
Gender:F
Credentials:MA, MT-BC, CTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 BRUGGER PL
Mailing Address - Street 2:
Mailing Address - City:MC FARLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53558-9553
Mailing Address - Country:US
Mailing Address - Phone:515-577-0429
Mailing Address - Fax:
Practice Address - Street 1:3317 BRUGGER PL
Practice Address - Street 2:
Practice Address - City:MC FARLAND
Practice Address - State:WI
Practice Address - Zip Code:53558-9553
Practice Address - Country:US
Practice Address - Phone:515-577-0429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA10150101Y00000X
225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor