Provider Demographics
NPI:1821077827
Name:KUDZIA, KATHLEEN MARIE-SOHN (COUNSELOR PSYCHOLOGI)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE-SOHN
Last Name:KUDZIA
Suffix:
Gender:F
Credentials:COUNSELOR PSYCHOLOGI
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:SOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46920 RIVERWOODS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044
Mailing Address - Country:US
Mailing Address - Phone:586-915-1872
Mailing Address - Fax:586-412-0352
Practice Address - Street 1:46360 GRATIOT
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051
Practice Address - Country:US
Practice Address - Phone:586-948-0206
Practice Address - Fax:586-948-0213
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008019101YP2500X
MI6301011792103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist