Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | C-00560 | MI |
Y | 102L00000X | Psychologist | 6301018041 | MI |
Y | 103T00000X | Psychologist | 6301018041 | MI |
NPI | 1003026824 |
---|---|
Provider Name | Dr. Elizabeth Pangrazzi |
First Address | Iron Mountain, MI 49801-4722 |
Second Address | Iron Mountain, MI 49801-4722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 24/04/2020 |