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General NPI Number Information
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NPI Number | 1386318558
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Entity Type | Individual
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Provider Name | KATHERINE MARILYN GARDNER
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Gender | Female
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Dates
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Enumeration Date | 08/02/2021
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 2470 COLLINGWOOD ST
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City | DETROIT
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State | MI
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Zip | 48206-1500
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Country | US
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Telephone | 313-437-1549
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Fax |
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Provider Business Mailing Address
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Address Line | 307 WASHINGTON ST
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City | MONROE
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State | MI
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Zip | 48161-2147
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Country | US
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Telephone | 734-625-4080
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 6851103567
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License Number State | MI
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