Provider Demographics
NPI:1487935532
Name:STONER, KATRINA JORDAN (LMSWC)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:JORDAN
Last Name:STONER
Suffix:
Gender:F
Credentials:LMSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3401
Mailing Address - Country:US
Mailing Address - Phone:906-376-4120
Mailing Address - Fax:
Practice Address - Street 1:1024 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3401
Practice Address - Country:US
Practice Address - Phone:906-376-4120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19423104100000X, 1041C0700X
MI68011028101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD609550001Medicaid
MDR968OtherCAREFIRST BCBS
MD346646OtherMHN/TRICARE
MD7840093OtherAETNA
MD259147-000OtherMAGELLAN BEHAVIORAL HEALTH
MD517251OtherOPTUM/UBH
MD517251OtherOPTUM/UBH