Provider Demographics
NPI:1184775256
Name:POWELL, KATHLEEN MARY (NATIONALLY CERTIFIED)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARY
Last Name:POWELL
Suffix:
Gender:F
Credentials:NATIONALLY CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 S WAGNER RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1939
Mailing Address - Country:US
Mailing Address - Phone:734-669-2975
Mailing Address - Fax:
Practice Address - Street 1:249 S WAGNER RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1939
Practice Address - Country:US
Practice Address - Phone:734-669-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor