Provider Demographics
NPI:1720820434
Name:KOGLIN, CATHERINE ANN (MS, LCGC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:KOGLIN
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LCGC
Mailing Address - Street 1:1045 N COLLON DR
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9190
Mailing Address - Country:US
Mailing Address - Phone:248-425-8861
Mailing Address - Fax:
Practice Address - Street 1:1045 N COLLON DR
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9190
Practice Address - Country:US
Practice Address - Phone:248-425-8861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC001264170300000X
MI7201000025170300000X
MAGC772170300000X
MN1576170300000X
ALGC270170300000X
ARLGC-0406170300000X
LA335291170300000X
IN74000587A170300000X
IAGC-0417170300000X
MDG0000250170300000X
KYGC409170300000X
DECG-0010329170300000X
FLGC73170300000X
GA345170300000X
IL246000584170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS