Provider Demographics
NPI:1750512331
Name:KALTZ, STACIE ANN (BSW,QMRP)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:ANN
Last Name:KALTZ
Suffix:
Gender:F
Credentials:BSW,QMRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 380710
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-0070
Mailing Address - Country:US
Mailing Address - Phone:586-263-8997
Mailing Address - Fax:586-263-1435
Practice Address - Street 1:16200 19 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1103
Practice Address - Country:US
Practice Address - Phone:586-263-8997
Practice Address - Fax:586-263-1435
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker