Provider Demographics
NPI:1831180751
Name:GRIFFIN, KATHLEEN NAOMI (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:NAOMI
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:NAOMI
Other - Last Name:GRIFFIN-STEGINK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:3068 SPRINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49004-9672
Mailing Address - Country:US
Mailing Address - Phone:269-342-2897
Mailing Address - Fax:269-344-5819
Practice Address - Street 1:309 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5176
Practice Address - Country:US
Practice Address - Phone:269-342-2897
Practice Address - Fax:269-344-5819
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008379103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680C94576OtherBCBS NONPAR PROVIDER #
MI0M04880Medicare ID - Type UnspecifiedPROVIDER #