1033917299 NPI number — KATHRYN ALLY FABIAN STETLER LLMSW

Table of content: KATHRYN ALLY FABIAN STETLER LLMSW (NPI 1033917299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033917299 NPI number — KATHRYN ALLY FABIAN STETLER LLMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FABIAN STETLER
Provider First Name:
KATHRYN
Provider Middle Name:
ALLY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LLMSW
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:
1033917299
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28345 BECK RD STE 305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WIXOM
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48393-4744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-408-1149
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28345 BECK RD STE 305
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WIXOM
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48393-4744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-408-1149
Provider Business Practice Location Address Fax Number:
734-786-1252
Provider Enumeration Date:
03/04/2025

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: 1041C0700X , with the licence number:  6851119224 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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