1699822932 NPI number — DR. KATHRYN SUSAN WURTZ PSY.D.

Table of content: (NPI 1962752378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699822932 NPI number — DR. KATHRYN SUSAN WURTZ PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WURTZ
Provider First Name:
KATHRYN
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699822932
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 MULL AVE
Provider Second Line Business Mailing Address:
EMERGE MINISTRIES
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44313-7502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-867-5603
Provider Business Mailing Address Fax Number:
330-873-3439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 MULL AVE
Provider Second Line Business Practice Location Address:
EMERGE MINISTRIES
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44313-7502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-867-5603
Provider Business Practice Location Address Fax Number:
330-873-3439
Provider Enumeration Date:
01/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  5280 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000025889 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341213335 . This is a "CORPHEALTH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 6183522 . This is a "UBH & UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7560434 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2047878 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34-1213335-032 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 268409000 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 216197 . This is a "VALUE OPTIONS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341213335KW . This is a "SUMMACARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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