Provider Demographics
NPI:1881032878
Name:BRISTOL, KATHERINE (MSW, LMSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BRISTOL
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1539
Mailing Address - Country:US
Mailing Address - Phone:989-787-0028
Mailing Address - Fax:989-331-6790
Practice Address - Street 1:441 N STATE ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1539
Practice Address - Country:US
Practice Address - Phone:989-787-0028
Practice Address - Fax:989-331-6790
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010861551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical