| Kathryn Penfold M., Sc, Llc | |
|
820 W Front St Traverse City MI 49684-2466 | |
| (231) 590-6242 | |
| Not Available |
| Full Name | Kathryn Penfold M., Sc, Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 820 W Front St, Traverse City, Michigan |
| Authorized Official Name and Position | Kathryn J Penfold (SOLE MEMBER) |
| Authorized Official Contact | 2315906242 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kathryn Penfold M., Sc, Llc 820 W Front St Traverse City MI 49684-2466 Ph: (231) 590-6242 | Kathryn Penfold M., Sc, Llc 820 W Front St Traverse City MI 49684-2466 Ph: (231) 590-6242 |
| NPI Number | 1205223468 |
|---|---|
| Provider Enumeration Date | 04/24/2015 |
| Last Update Date | 04/24/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205223468 | NPI | - | NPPES |
| 1336325281 | Other | MI | INDIVIDUAL NPI OF SOLE MEMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 6301008173 (Michigan) | Primary |
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