Provider Information for 1417653478
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KATIE SUZANNE ESTELLE LMSW
Other Names:Former Name:KATIE SUZANNE BOSHANSSex: Female
NPI: 1417653478
Last Updated: 2023-02-01
Certification Date: 2023-02-01
Certification Date: 2023-02-01
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1417653478 | ||||||||
| Enumeration Date | 2023-02-01 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2138 5TH ST BAY CITY, MI 48708-6344 United States Phone: 989-482-4008 | Fax: | ||||||||
| Primary Practice Address | 2138 5TH ST BAY CITY, MI 48708-6344 United States Phone: 989-482-4008 | Fax: | ||||||||
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