Active NPI
Kathleen Margaret Hagelthorn, PH.D.
- Clinical Neuropsychologist
- Detroit, MI
National Provider Identifier
1215295191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 6301014115
- Practice address
- 1 Ford PL Ste 2E
Detroit, MI 48202-3450 - Phone
- (313) 874-4689
- NPI assigned
- Apr 27, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 6301014115 | MI | Primary |
Addresses
Primary practice location
1 Ford PL Ste 2E
Detroit, MI 48202-3450
Mailing address
One Ford Place, Ste 2E
Henry Ford Health System
Detroit, MI 48202
Phone (313) 874-4689
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301014115 | MI | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335484800000",
"number": "1215295191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "ONE FORD PLACE, STE 2E",
"address_2": "HENRY FORD HEALTH SYSTEM",
"city": "DETROIT",
"state": "MI",
"postal_code": "48202",
"telephone_number": "313-874-4689"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 FORD PL STE 2E",
"city": "DETROIT",
"state": "MI",
"postal_code": "482023450",
"telephone_number": "313-874-4689"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAGELTHORN",
"first_name": "KATHLEEN",
"middle_name": "MARGARET",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-04-27",
"last_updated": "2012-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "MI",
"license": "6301014115",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.