Provider Demographics
NPI:1134994403
Name:KATERBERG, CODY A (LLMSW)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:A
Last Name:KATERBERG
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5388 EFFINGHAM DR SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-6308
Mailing Address - Country:US
Mailing Address - Phone:616-322-3114
Mailing Address - Fax:
Practice Address - Street 1:507 S NELSON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-2197
Practice Address - Country:US
Practice Address - Phone:616-754-9420
Practice Address - Fax:616-754-9419
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty