Provider Demographics
NPI:1437481785
Name:KUECKEN, ANN MARIE (MA, LPC)
Entity Type:Individual
Prefix:MISS
First Name:ANN
Middle Name:MARIE
Last Name:KUECKEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MISS
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:KUECKEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5796 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EAST CHINA
Mailing Address - State:MI
Mailing Address - Zip Code:48054-4727
Mailing Address - Country:US
Mailing Address - Phone:248-872-2199
Mailing Address - Fax:
Practice Address - Street 1:1322 RIVER RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-2803
Practice Address - Country:US
Practice Address - Phone:810-329-4798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883825Medicaid