Provider Demographics
NPI:1366837858
Name:LARD, KATHY (LLMSW)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:LARD
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 ROMENCE RD STE 211A
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-3400
Mailing Address - Country:US
Mailing Address - Phone:269-235-0154
Mailing Address - Fax:
Practice Address - Street 1:640 ROMENCE RD STE 211A
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-3400
Practice Address - Country:US
Practice Address - Phone:269-235-0154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801097733104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker