Healthcare Provider Details

I. General information

NPI: 1073435681
Provider Name (Legal Business Name): MRS. KATHERINE MARIE BRKLJACIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 JOLIET ST
DYER IN
46311-1705
US

IV. Provider business mailing address

24 JOLIET ST
DYER IN
46311-1705
US

V. Phone/Fax

Practice location:
  • Phone: 219-515-3014
  • Fax:
Mailing address:
  • Phone: 219-515-3014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number39003247A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: