Individual provider Active NPI

Katherine Dawn Gimmestad, PH.D.

  • Clinical Psychologist
  • Brighton, MI
National Provider Identifier
1699116228
Registry record updated Sep 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301015590 Issued in MI
Practice address
1040 Lake Ridge Dr
Brighton, MI 48114-8757
Phone
(816) 305-1659
Fax
(810) 222-7036
NPI assigned
Jul 11, 2013
Last updated
Sep 2, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 6301015590 MI Primary

Addresses

Primary practice location

1040 Lake Ridge Dr
Brighton, MI 48114-8757

Mailing address

1040 Lake Ridge Dr
Brighton, MI 48114-8757
Phone (816) 305-1659

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230314002170 MI Practitioner - Psychologist Billing Independently 2567836562 Practice locations: Brighton, MI

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
6301015590MIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Katherine Gimmestad, PHD, LLC Clinical PastSince Apr 19, 2021 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1373500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788307200000",
    "number": "1699116228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 LAKE RIDGE DR",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481148757",
            "telephone_number": "816-305-1659",
            "fax_number": "810-222-7036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 LAKE RIDGE DR",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481148757",
            "telephone_number": "816-305-1659",
            "fax_number": "810-222-7036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIMMESTAD",
        "first_name": "KATHERINE",
        "middle_name": "DAWN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-11",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301015590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brighton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.