Provider Demographics
NPI:1215178306
Name:KATTULA-KLINK, CATHERINE ANNE (LMSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANNE
Last Name:KATTULA-KLINK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:ANNE
Other - Last Name:KATTULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:950 W MONROE ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2079
Mailing Address - Country:US
Mailing Address - Phone:517-788-8330
Mailing Address - Fax:517-788-5952
Practice Address - Street 1:950 W MONROE ST
Practice Address - Street 2:SUITE 500
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2079
Practice Address - Country:US
Practice Address - Phone:517-788-8330
Practice Address - Fax:517-788-5952
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010817591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical