Provider Demographics
NPI:1871769224
Name:LOESEL-STRAUCH, KATHLEEN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:LOESEL-STRAUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34556 BUNKER HILL DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3225
Mailing Address - Country:US
Mailing Address - Phone:248-579-0856
Mailing Address - Fax:248-786-5324
Practice Address - Street 1:43996 WOODWARD AVE
Practice Address - Street 2:SUITE 02
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5027
Practice Address - Country:US
Practice Address - Phone:248-579-0856
Practice Address - Fax:248-786-5324
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010876051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical