Provider Demographics
NPI:1417653478
Name:ESTELLE, KATIE SUZANNE (LMSW)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:SUZANNE
Last Name:ESTELLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:SUZANNE
Other - Last Name:BOSHANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2138 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-6344
Mailing Address - Country:US
Mailing Address - Phone:989-482-4008
Mailing Address - Fax:
Practice Address - Street 1:2138 5TH ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6344
Practice Address - Country:US
Practice Address - Phone:989-482-4008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011147441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical