Provider Demographics
NPI:1215241161
Name:GROTH, KAREN MARIE (EDD, LLP)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MARIE
Last Name:GROTH
Suffix:
Gender:F
Credentials:EDD, LLP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:MARIE
Other - Last Name:WICKLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD, LLP
Mailing Address - Street 1:15910 CAMPERDOWN AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-2107
Mailing Address - Country:US
Mailing Address - Phone:248-733-3907
Mailing Address - Fax:
Practice Address - Street 1:15910 CAMPERDOWN AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-2107
Practice Address - Country:US
Practice Address - Phone:248-733-3907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014516103TC0700X
MI6361003201103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical