Kathleen June Konwiak, LLP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301004046 Issued in MI

Practice address

22151 Moross Rd
PB1 Suite 334
Detroit, MI 48236-2167

Phone

(313) 343-8784

Fax

(313) 343-7449

NPI assigned

Oct 4, 2006

Last updated

Jan 30, 2017By the provider in NPPES

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

• Kathleen June Heinrich/Maddocks 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": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485734400000",
    "number": "1922194612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28000 DEQUINDRE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "48092",
            "telephone_number": "586-753-0405",
            "fax_number": "586-753-0404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22151 MOROSS RD",
            "address_2": "PB1 SUITE 334",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362167",
            "telephone_number": "313-343-8784",
            "fax_number": "313-343-7449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONWIAK",
        "first_name": "KATHLEEN",
        "middle_name": "JUNE",
        "credential": "LLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2017-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301004046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHLEEN",
            "last_name": "HEINRICH/MADDOCKS",
            "middle_name": "JUNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nicholas Peter Konowitz, MD
• Katherine Elizabeth Konrad, NP
• Laura Dorothy Konsitzke, PA-C
• Danica Kontic
• Natalie Renee Kontos, DO
• Mahtab Koochaki, PT, DPT
• Breanna Kooienga
• Beverly A Koonce
• Jasmeet Kaur Kooner
• Kristine Koos, LLMSW

• Psychologist in Detroit, MI
• Providers in Detroit, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; 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.