MEDICARE: KATHRYN MENIG LMSW, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6801089188	OTHER	MI	LICENSE NUMBER

General Provider Information

NPI Number	:	1003405614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHRYN MENIG LMSW, LLC

Provider Business Mailing Address
First Line	:	31363 W RUTLAND ST
Second Line	:
City	:	BEVERLY HILLS
State	:	MI
Zip	:	48025-5433
Country	:	US
Telephone Number	:	248-225-0872
Fax Number	:

Provider Business Practice Location Address
First Line	:	31363 W RUTLAND ST
Second Line	:
City	:	BEVERLY HILLS
State	:	MI
Zip	:	48025-5433
Country	:	US
Telephone Number	:	248-225-0872
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MEGAN MCCLAIN
Credential	:
Telephone Number	:	248-249-1520

Provider Enumeration Date	:	01/18/2021
Last Update Date	:	01/18/2021

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