Provider Demographics
NPI:1649058272
Name:GRACER, KATHERINE HELENE (BSW, MSP)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:HELENE
Last Name:GRACER
Suffix:
Gender:F
Credentials:BSW, MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 HALLMARK CT
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2107
Mailing Address - Country:US
Mailing Address - Phone:989-790-3366
Mailing Address - Fax:
Practice Address - Street 1:3190 HALLMARK CT
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2107
Practice Address - Country:US
Practice Address - Phone:989-790-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103TA0400X, 104100000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker