Provider Demographics
NPI:1265888317
Name:BROEKHUIZEN, KATHERINE (LMSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BROEKHUIZEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 775316
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5316
Mailing Address - Country:US
Mailing Address - Phone:586-493-8010
Mailing Address - Fax:586-493-8183
Practice Address - Street 1:1000 HARRINGTON ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2920
Practice Address - Country:US
Practice Address - Phone:586-493-8010
Practice Address - Fax:586-493-8183
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical