Healthcare Provider Details

I. General information

NPI: 1841677895
Provider Name (Legal Business Name): KATHLEEN R EVERITT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 WILSON AVE NW
WALKER MI
49534
US

IV. Provider business mailing address

PO BOX 776974
CHICAGO IL
60677-6974
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-8650
  • Fax: 616-791-2160
Mailing address:
  • Phone: 4-945-7978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801082829
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: