1821077827 NPI number — MS. KATHLEEN MARIE-SOHN KUDZIA COUNSELOR PSYCHOLOGI

Table of content: MS. KATHLEEN MARIE-SOHN KUDZIA COUNSELOR PSYCHOLOGI (NPI 1821077827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821077827 NPI number — MS. KATHLEEN MARIE-SOHN KUDZIA COUNSELOR PSYCHOLOGI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUDZIA
Provider First Name:
KATHLEEN
Provider Middle Name:
MARIE-SOHN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
COUNSELOR PSYCHOLOGI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOHN
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821077827
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
46920 RIVERWOODS DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACOMB
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-915-1872
Provider Business Mailing Address Fax Number:
586-412-0352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46360 GRATIOT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-948-0206
Provider Business Practice Location Address Fax Number:
586-948-0213
Provider Enumeration Date:
01/10/2006

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: 101YP2500X , with the licence number:  6401008019 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103T00000X , with the licence number: 6301011792 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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