Healthcare Provider Details

I. General information

NPI: 1528977931
Provider Name (Legal Business Name): KATHERINE GIMMESTAD, PHD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 LAKE RIDGE DR
BRIGHTON MI
48114-8757
US

IV. Provider business mailing address

1040 LAKE RIDGE DR
BRIGHTON MI
48114-8757
US

V. Phone/Fax

Practice location:
  • Phone: 816-305-1659
  • Fax: 810-222-7036
Mailing address:
  • Phone: 816-305-1659
  • Fax: 810-222-7036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHERINE DAWN GIMMESTAD
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 816-305-1659