Provider Demographics
NPI:1306032677
Name:TIEFENTHAL, KATHRYN BOEGEL (MSW)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:BOEGEL
Last Name:TIEFENTHAL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151 W B AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-8602
Mailing Address - Country:US
Mailing Address - Phone:269-343-8843
Mailing Address - Fax:
Practice Address - Street 1:103 S 4TH ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1819
Practice Address - Country:US
Practice Address - Phone:269-651-3902
Practice Address - Fax:269-659-4874
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020660291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical