Basic Information
| Provider Information | |||||||||
| NPI: | 1821077827 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUDZIA | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | MARIE-SOHN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | COUNSELOR PSYCHOLOGI | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SOHN | ||||||||
| OtherFirstName: | KATHLEEN | ||||||||
| OtherMiddleName: | MARIE | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 46920 RIVERWOODS DRIVE | ||||||||
| Address2: | |||||||||
| City: | MACOMB | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5869151872 | ||||||||
| FaxNumber: | 5864120352 | ||||||||
| Practice Location | |||||||||
| Address1: | 46360 GRATIOT | ||||||||
| Address2: | |||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5869480206 | ||||||||
| FaxNumber: | 5869480213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 05/20/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401008019 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 103T00000X | 6301011792 | MI | N | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.