Provider Demographics
NPI:1134396427
Name:KOLACZ, CATHERINE ANNE
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANNE
Last Name:KOLACZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:ANNE
Other - Last Name:KIDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:212 1/2 WASHINGTON AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-3316
Mailing Address - Country:US
Mailing Address - Phone:616-419-8591
Mailing Address - Fax:
Practice Address - Street 1:212 1/2 WASHINGTON AVE STE 3
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-3316
Practice Address - Country:US
Practice Address - Phone:616-419-8591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010904421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1134396427Medicaid