Provider Demographics
NPI:1356598346
Name:KAUTZ, JANNA LYNN (PHD)
Entity type:Individual
Prefix:MS
First Name:JANNA
Middle Name:LYNN
Last Name:KAUTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 E FORT LOWELL RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2326
Mailing Address - Country:US
Mailing Address - Phone:520-296-4280
Mailing Address - Fax:
Practice Address - Street 1:1980 E FORT LOWELL RD
Practice Address - Street 2:SUITE 150
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2326
Practice Address - Country:US
Practice Address - Phone:520-296-4280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4429103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist