Provider Demographics
NPI:1194610550
Name:KAUTZ, MALLORY (MA)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:KAUTZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 S MACKENZIE LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-8915
Mailing Address - Country:US
Mailing Address - Phone:989-255-8693
Mailing Address - Fax:
Practice Address - Street 1:304 W WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-7264
Practice Address - Country:US
Practice Address - Phone:989-492-7766
Practice Address - Fax:989-495-0532
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7152001177235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist