Healthcare Provider Details

I. General information

NPI: 1285100107
Provider Name (Legal Business Name): KATHERINE MIELKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 CRAMER CREEK CT
DUBLIN OH
43017-2586
US

IV. Provider business mailing address

299 CRAMER CREEK CT
DUBLIN OH
43017-2586
US

V. Phone/Fax

Practice location:
  • Phone: 614-889-5722
  • Fax:
Mailing address:
  • Phone: 614-403-1955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.1903870
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: