Provider Demographics
NPI:1104238419
Name:FRITZ, KATHRYN (LAC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:FRITZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 MORRISON ST
Mailing Address - Street 2:APT 3
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3814
Mailing Address - Country:US
Mailing Address - Phone:608-556-3277
Mailing Address - Fax:
Practice Address - Street 1:1450 MORRISON ST
Practice Address - Street 2:APT 3
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3814
Practice Address - Country:US
Practice Address - Phone:608-556-3277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI764-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist