Healthcare Provider Details

I. General information

NPI: 1477150761
Provider Name (Legal Business Name): CATHERINE HARDWICK LMSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

569 WILDWOOD AVE UNIT 4
JACKSON MI
49201-1048
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 517-917-3563
  • Fax:
Mailing address:
  • Phone: 517-676-9788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MARYBETH HOUPT
Title or Position: CREDENTIALING
Credential:
Phone: 517-676-9788