Healthcare Provider Details

I. General information

NPI: 1578470316
Provider Name (Legal Business Name): KATHERINE SUZANNE VANWIENEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S MISSION ST B MOUNT PLEASANT MICHIGAN 48858 SUITE B
MOUNT PLEASANT MI
49015-7953
US

IV. Provider business mailing address

405 S MISSION ST. SUITE B MOUNT PLEASANT 48858
MOUNT PLEASANT MI
48858
US

V. Phone/Fax

Practice location:
  • Phone: 989-815-2157
  • Fax: 269-832-5814
Mailing address:
  • Phone: 989-815-2157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: