Provider Demographics
NPI:1447897434
Name:MINKS, KATHERINE ELIZABETH (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:MINKS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4676 THORNBERRY HILL CT NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9489
Mailing Address - Country:US
Mailing Address - Phone:616-914-7310
Mailing Address - Fax:
Practice Address - Street 1:3501 LAKE EASTBROOK BLVD SE STE 120
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5939
Practice Address - Country:US
Practice Address - Phone:616-914-7310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68001997931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical