Kathryn Penfold M., SC, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301008173 Issued in MI

Legal business name

KATHRYN PENFOLD M., SC, LLC

Practice address

820 W Front St
Traverse City, MI 49684-2466

Phone

(231) 590-6242

NPI assigned

Apr 24, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kathryn J Penfold, M, SC

Title

Sole Member

Phone

(231) 590-6242

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429833600000",
    "number": "1205223468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 W FRONT ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842466",
            "telephone_number": "231-590-6242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 W FRONT ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842466",
            "telephone_number": "231-590-6242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATHRYN PENFOLD M., SC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-24",
        "last_updated": "2015-04-24",
        "status": "A",
        "authorized_official_last_name": "PENFOLD",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "231-590-6242",
        "authorized_official_credential": "M, SC"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301008173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI OF SOLE MEMBER",
            "identifier": "1336325281",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Annelle Kaspor, RN,MPH,FNP-C
• Charles Philip Kass, DDS MS
• Maya Lynn Kassab
• Katharine Westie PHD PLLC
• Katherine a Roth MD PLC
• Isaac Kaufman, M.D.
• Kerry M Kaysserian, DDS
• Kendra Kearney, MSW
• Amy N Keck, LMSW
• Amy Joan Keen, FNP-BC

• Clinical Psychologist in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.