Provider Demographics
NPI:1194346486
Name:MIECZKOWSKI, KATHERINE A
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:A
Last Name:MIECZKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KATHERINE
Other - Middle Name:A
Other - Last Name:GILASZEWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:235 S. CENTER #7
Mailing Address - Street 2:
Mailing Address - City:BURTEN
Mailing Address - State:MI
Mailing Address - Zip Code:48509
Mailing Address - Country:US
Mailing Address - Phone:248-845-4714
Mailing Address - Fax:248-282-4280
Practice Address - Street 1:235 S. CENTER #7
Practice Address - Street 2:
Practice Address - City:BURTEN
Practice Address - State:MI
Practice Address - Zip Code:48509
Practice Address - Country:US
Practice Address - Phone:248-845-4714
Practice Address - Fax:248-282-4280
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501004917237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist