Provider Demographics
NPI:1003989286
Name:WEEKS MIELKE, KATHLEEN (MS,MA)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:WEEKS MIELKE
Suffix:
Gender:F
Credentials:MS,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 ROCHESTER RD STE 460
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1277
Mailing Address - Country:US
Mailing Address - Phone:248-828-3030
Mailing Address - Fax:248-828-1010
Practice Address - Street 1:6915 ROCHESTER RD STE 460
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1277
Practice Address - Country:US
Practice Address - Phone:248-828-3030
Practice Address - Fax:248-828-1010
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006290103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist