Provider Demographics
NPI:1447733787
Name:SMAGUR, KATHRYN (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:SMAGUR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 WINDWOOD DR APT 58
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1489
Mailing Address - Country:US
Mailing Address - Phone:773-905-9197
Mailing Address - Fax:
Practice Address - Street 1:1200 S DETROIT AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-5903
Practice Address - Country:US
Practice Address - Phone:419-213-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017401103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical