Katelynn Mack

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6851114022 Issued in MI

Practice address

411 W Lake Lansing Rd Ste C125
East Lansing, MI 48823-8485

Phone

(616) 617-0446

NPI assigned

Sep 27, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Katelynn Diepstra Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1727395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1821816091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3118 AVERILL DR",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489111401",
            "telephone_number": "616-617-0446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 W LAKE LANSING RD STE C125",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488238485",
            "telephone_number": "616-617-0446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "KATELYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-27",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6851114022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATELYNN",
            "last_name": "DIEPSTRA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Keith Edward Lyon, PH.D.
• M78 Services LLC
• Leslie Greene Macauley, MD
• David Mack, D.O.
• Emily Mack
• Susan Jean Mackenzie, NP
• Thomas Mackowiak, ATC
• Chloe Macnee
• Neth Suvindu Madawala
• Carol L Maddox

• Clinical Social Worker in East Lansing, MI
• Providers in East Lansing, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; 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.