Healthcare Provider Details

I. General information

NPI: 1760814008
Provider Name (Legal Business Name): KATHRYN MARY PEARCH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40435 DELTA DR
NORTHVILLE MI
48168-3237
US

IV. Provider business mailing address

40435 DELTA DR
NORTHVILLE MI
48168-3237
US

V. Phone/Fax

Practice location:
  • Phone: 248-761-2154
  • Fax:
Mailing address:
  • Phone: 248-761-2154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090327
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6801090327
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: