Provider Demographics
NPI:1194966770
Name:DEMAAGD, KATHRYN (LLP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:DEMAAGD
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:DEMAAGD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1776 WILDWOOD HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:BOYNE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49712-9196
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1776 WILDWOOD HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:BOYNE CITY
Practice Address - State:MI
Practice Address - Zip Code:49712-9196
Practice Address - Country:US
Practice Address - Phone:231-675-9766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014086103T00000X
MI6401011153101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional