Healthcare Provider Details

I. General information

NPI: 1699116228
Provider Name (Legal Business Name): KATHERINE DAWN GIMMESTAD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2013
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 Number6301015590
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: