Provider Demographics
NPI:1578590907
Name:DRINKWATER, KATHRYN K (MSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:K
Last Name:DRINKWATER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:K
Other - Last Name:DRINKWATER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:1785 W STADIUM BLVD
Mailing Address - Street 2:SUITE 201-E
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5285
Mailing Address - Country:US
Mailing Address - Phone:734-277-4976
Mailing Address - Fax:
Practice Address - Street 1:1785 W STADIUM BLVD
Practice Address - Street 2:SUITE 201-E
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5285
Practice Address - Country:US
Practice Address - Phone:734-277-4976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010341981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008940700OtherBLUE CARE NETWORK
MI0899166OtherBCBSM
MI800894070OtherBCBS OF MI
MI800894070OtherBCBS OF MI