Provider Demographics
NPI:1508107160
Name:ST. JOHN, KATHARINE NICOLE (BA, QMHP)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:NICOLE
Last Name:ST. JOHN
Suffix:
Gender:F
Credentials:BA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 E COURT ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-4054
Mailing Address - Country:US
Mailing Address - Phone:810-232-6081
Mailing Address - Fax:810-232-6510
Practice Address - Street 1:2811 E COURT ST
Practice Address - Street 2:SUITE F
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-4054
Practice Address - Country:US
Practice Address - Phone:810-232-6081
Practice Address - Fax:810-232-6510
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator