Provider Demographics
NPI:1457030330
Name:KAUZLARICH, DAMIZELLE
Entity Type:Individual
Prefix:
First Name:DAMIZELLE
Middle Name:
Last Name:KAUZLARICH
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 1:270 IRONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:IA
Mailing Address - Zip Code:50006-8005
Mailing Address - Country:US
Mailing Address - Phone:413-733-4836
Mailing Address - Fax:
Practice Address - Street 1:1611 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-2831
Practice Address - Country:US
Practice Address - Phone:515-832-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22023101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)