Provider Demographics
NPI:1013701812
Name:STOCKWELL, KAREN M
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:STOCKWELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5428 FRED J BAKER LN
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:MI
Mailing Address - Zip Code:48049-2011
Mailing Address - Country:US
Mailing Address - Phone:810-300-6711
Mailing Address - Fax:
Practice Address - Street 1:5428 FRED J BAKER LN
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:MI
Practice Address - Zip Code:48049-2011
Practice Address - Country:US
Practice Address - Phone:810-300-6711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor