Provider Demographics
NPI:1497510556
Name:CRITTENDEN, KATELYN LEE
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:LEE
Last Name:CRITTENDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1628
Mailing Address - Country:US
Mailing Address - Phone:810-730-5520
Mailing Address - Fax:
Practice Address - Street 1:1057 E COLDWATER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-1501
Practice Address - Country:US
Practice Address - Phone:810-257-3740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No174H00000XOther Service ProvidersHealth Educator