Healthcare Provider Details

I. General information

NPI: 1386318558
Provider Name (Legal Business Name): KATHERINE MARILYN GARDNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE LAURAIN

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 COLLINGWOOD ST
DETROIT MI
48206-1500
US

IV. Provider business mailing address

307 WASHINGTON ST
MONROE MI
48161-2147
US

V. Phone/Fax

Practice location:
  • Phone: 313-437-1549
  • Fax:
Mailing address:
  • Phone: 734-625-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801121802
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6851103567
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: