Provider Demographics
NPI:1598328965
Name:PAULBECK, KATHLEEN ANN (CPCC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:PAULBECK
Suffix:
Gender:F
Credentials:CPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2912
Mailing Address - Country:US
Mailing Address - Phone:734-716-7898
Mailing Address - Fax:
Practice Address - Street 1:7800 W OUTER DR STE 203
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3459
Practice Address - Country:US
Practice Address - Phone:313-259-1574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-20
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator