Provider Demographics
NPI:1932167491
Name:HARDWICK, CATHERINE LOUISE (CSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LOUISE
Last Name:HARDWICK
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:LOUISE
Other - Last Name:HAGEMYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:517-676-9788
Mailing Address - Fax:
Practice Address - Street 1:569 WILDWOOD AVE UNIT 4
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1048
Practice Address - Country:US
Practice Address - Phone:517-917-3563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801071699104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI800011045OtherRR MEDICARE
MIP17694Medicare UPIN