Provider Demographics
NPI:1952569378
Name:MIZZI, KATHRYN E (LMSW MSW ACSW)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:E
Last Name:MIZZI
Suffix:
Gender:F
Credentials:LMSW MSW ACSW
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 303
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNACE
Mailing Address - State:MI
Mailing Address - Zip Code:49781
Mailing Address - Country:US
Mailing Address - Phone:906-643-7035
Mailing Address - Fax:906-643-7467
Practice Address - Street 1:720 W US-2 SUITE D
Practice Address - Street 2:
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781
Practice Address - Country:US
Practice Address - Phone:906-643-7035
Practice Address - Fax:906-643-7467
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010737721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical