Provider Demographics
NPI:1710633805
Name:HOOVER, KATHRYN ANNE-LAUER
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANNE-LAUER
Last Name:HOOVER
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 1:7884 N KILKENNY DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6238
Mailing Address - Country:US
Mailing Address - Phone:616-745-1488
Mailing Address - Fax:
Practice Address - Street 1:2750 CARPENTER RD STE 5
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1170
Practice Address - Country:US
Practice Address - Phone:616-745-1488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022051101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty