Provider Demographics
NPI:1083153779
Name:JIMENEZ, KATHARINE L (LLBSW)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:L
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:L
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 N WEST AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2179
Mailing Address - Country:US
Mailing Address - Phone:517-796-4525
Mailing Address - Fax:517-789-1286
Practice Address - Street 1:1200 N WEST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2179
Practice Address - Country:US
Practice Address - Phone:517-796-4525
Practice Address - Fax:517-789-1286
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802086628104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker