Provider Demographics
NPI:1598497497
Name:NORTZ, KATHERINE THERESE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:THERESE
Last Name:NORTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:THERESE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CT
Mailing Address - Street 1:1930 WAGAR RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-2317
Mailing Address - Country:US
Mailing Address - Phone:931-217-9912
Mailing Address - Fax:
Practice Address - Street 1:737 BOLIVAR RD STE 300
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-1246
Practice Address - Country:US
Practice Address - Phone:931-217-9912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2405658-TRNE101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2871101Medicaid