Healthcare Provider Details

I. General information

NPI: 1932167491
Provider Name (Legal Business Name): CATHERINE LOUISE HARDWICK CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE LOUISE HAGEMYER

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
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 Number6801071699
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: