Provider Demographics
NPI:1477380962
Name:MAZUR, KATHRYN LEE (LPC-IT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LEE
Last Name:MAZUR
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-3708
Mailing Address - Country:US
Mailing Address - Phone:218-212-3435
Mailing Address - Fax:218-234-2993
Practice Address - Street 1:2207 E 5TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-3708
Practice Address - Country:US
Practice Address - Phone:218-212-3435
Practice Address - Fax:218-234-2993
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7405-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional