Provider Demographics
NPI:1952343774
Name:DUNLOP, KATHERINE K (LMSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:K
Last Name:DUNLOP
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 1:1899 HARLEY DR
Mailing Address - Street 2:OPTIONAL
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-8974
Mailing Address - Country:US
Mailing Address - Phone:773-682-0189
Mailing Address - Fax:
Practice Address - Street 1:1899 HARLEY DR
Practice Address - Street 2:OPTIONAL
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-8974
Practice Address - Country:US
Practice Address - Phone:773-682-0189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.011536104100000X
MI68010971851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK24280Medicare ID - Type Unspecified