Provider Demographics
NPI:1437533361
Name:CARLSON, KATHRYN MCFADDEN (MSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MCFADDEN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:PHYLLIS
Other - Last Name:MCFADDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:430 N CROOKS RD
Mailing Address - Street 2:APT 37
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1302
Mailing Address - Country:US
Mailing Address - Phone:574-312-5396
Mailing Address - Fax:
Practice Address - Street 1:24600 NORTHWESTERN HWY
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2471
Practice Address - Country:US
Practice Address - Phone:248-745-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010983081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical