Healthcare Provider Details

I. General information

NPI: 1922910660
Provider Name (Legal Business Name): KATHERINE GENTRY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ELIZABETH ST
SAUGATUCK MI
49453-9734
US

IV. Provider business mailing address

144 W 16TH ST
HOLLAND MI
49423-3323
US

V. Phone/Fax

Practice location:
  • Phone: 269-857-2133
  • Fax:
Mailing address:
  • Phone: 269-932-5305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801122785
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: