Provider Demographics
NPI:1548568900
Name:PRYOR, KATHARINE BRICKMAN (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:KATHARINE
Middle Name:BRICKMAN
Last Name:PRYOR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1291 MILLBROOK TRL
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-5913
Mailing Address - Country:US
Mailing Address - Phone:734-686-5309
Mailing Address - Fax:
Practice Address - Street 1:602 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1907
Practice Address - Country:US
Practice Address - Phone:517-783-5334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010720771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical