Healthcare Provider Details

I. General information

NPI: 1447735212
Provider Name (Legal Business Name): SOPHIA KATHERINE KOLBUS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3665 BAY RD
SAGINAW MI
48603-2445
US

IV. Provider business mailing address

121 LOCKWOOD ST
SAGINAW MI
48602-3025
US

V. Phone/Fax

Practice location:
  • Phone: 989-799-6542
  • Fax:
Mailing address:
  • Phone: 586-872-3108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801110573
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: