Provider Demographics
NPI:1699822932
Name:WURTZ, KATHRYN SUSAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:SUSAN
Last Name:WURTZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MULL AVE
Mailing Address - Street 2:EMERGE MINISTRIES
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7502
Mailing Address - Country:US
Mailing Address - Phone:330-867-5603
Mailing Address - Fax:330-873-3439
Practice Address - Street 1:900 MULL AVE
Practice Address - Street 2:EMERGE MINISTRIES
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7502
Practice Address - Country:US
Practice Address - Phone:330-867-5603
Practice Address - Fax:330-873-3439
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5280103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000025889OtherANTHEM BCBS
OH341213335OtherCORPHEALTH
OH6183522OtherUBH & UNITED HEALTHCARE
OH7560434OtherAETNA
OH2047878Medicaid
OH34-1213335-032OtherCARESOURCE
OH268409000OtherMAGELLAN BEHAVIORAL HEALT
OH216197OtherVALUE OPTIONS
OH341213335KWOtherSUMMACARE
OH2047878Medicaid