Healthcare Provider Details

I. General information

NPI: 1558277970
Provider Name (Legal Business Name): KATHERINE ANDRESHAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 S HURON PKWY STE 3D
ANN ARBOR MI
48104-5133
US

IV. Provider business mailing address

14800 E OLD US HIGHWAY 12
CHELSEA MI
48118-2110
US

V. Phone/Fax

Practice location:
  • Phone: 734-719-0197
  • Fax:
Mailing address:
  • Phone: 734-719-0197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6362010427
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: