Provider Demographics
NPI:1235727835
Name:STEVENS, KATHERINE TAYLOR (BSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:TAYLOR
Last Name:STEVENS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3369 MILES RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8707
Mailing Address - Country:US
Mailing Address - Phone:517-630-1570
Mailing Address - Fax:
Practice Address - Street 1:3369 MILES RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-8707
Practice Address - Country:US
Practice Address - Phone:517-630-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health