Healthcare Provider Details

I. General information

NPI: 1184298812
Provider Name (Legal Business Name): KATELYN M BRITENRIKER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6220 BELMONT AVE NE
BELMONT MI
49306-9912
US

IV. Provider business mailing address

24794 US HIGHWAY 6
STRYKER OH
43557-9453
US

V. Phone/Fax

Practice location:
  • Phone: 616-327-2405
  • Fax: 616-259-4214
Mailing address:
  • Phone: 419-410-4861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW.09927884
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801108484
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1901580
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: