Provider Demographics
NPI:1326007147
Name:ETTENSON, KARA LYNN (LMSW, MSW)
Entity type:Individual
Prefix:MS
First Name:KARA
Middle Name:LYNN
Last Name:ETTENSON
Suffix:
Gender:F
Credentials:LMSW, MSW
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:PO BOX 67000
Mailing Address - Street 2:DEPARTMENT 272801
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-2728
Mailing Address - Country:US
Mailing Address - Phone:517-841-6913
Mailing Address - Fax:517-841-6917
Practice Address - Street 1:205 N EAST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-788-4730
Practice Address - Fax:517-788-4701
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI68010815611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical