Provider Demographics
NPI:1184081093
Name:WITKOWSKI, KATHERINE (TLLP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:WITKOWSKI
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N 2ND AVE UNIT 678
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-6229
Mailing Address - Country:US
Mailing Address - Phone:989-340-1645
Mailing Address - Fax:989-354-5898
Practice Address - Street 1:112 W CHISHOLM ST
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-2446
Practice Address - Country:US
Practice Address - Phone:989-340-1645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016421103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist