Healthcare Provider Details

I. General information

NPI: 1619509981
Provider Name (Legal Business Name): KATHERINE F DECELLE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 TOWNER ST
YPSILANTI MI
48198-5723
US

IV. Provider business mailing address

555 TOWNER ST
YPSILANTI MI
48198-5723
US

V. Phone/Fax

Practice location:
  • Phone: 734-544-3000
  • Fax: 734-544-6716
Mailing address:
  • Phone: 734-554-3050
  • Fax: 734-554-6732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801113520
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: