Provider Demographics
NPI:1841265360
Name:VEDRODY, KAREN E (LMSW)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:E
Last Name:VEDRODY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:V
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:4481 LENNON RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1064
Mailing Address - Country:US
Mailing Address - Phone:810-732-9451
Mailing Address - Fax:810-732-1002
Practice Address - Street 1:4481 LENNON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1064
Practice Address - Country:US
Practice Address - Phone:810-732-9451
Practice Address - Fax:810-732-1002
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010183991041C0700X
MI68010184071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08922791802Medicare ID - Type Unspecified