Provider Demographics
NPI:1982944518
Name:HARTZ, SUSIE (BA)
Entity type:Individual
Prefix:MRS
First Name:SUSIE
Middle Name:
Last Name:HARTZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1235
Mailing Address - Country:US
Mailing Address - Phone:989-619-9333
Mailing Address - Fax:
Practice Address - Street 1:111 S COURT AVE STE 100
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1351
Practice Address - Country:US
Practice Address - Phone:989-619-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383198322Medicaid