Provider Demographics
NPI:1154432730
Name:KURON, KATHLEEN ANNE (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANNE
Last Name:KURON
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANNE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, LLP
Mailing Address - Street 1:28000 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2468
Mailing Address - Country:US
Mailing Address - Phone:586-753-0405
Mailing Address - Fax:586-753-0404
Practice Address - Street 1:19120 CASS AVE
Practice Address - Street 2:CHIPPEWA VALLEY SCHOOLS - SPECIAL SERVICES DPT
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-2301
Practice Address - Country:US
Practice Address - Phone:586-723-2194
Practice Address - Fax:586-723-5801
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012574103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist