Provider Demographics
NPI:1902517352
Name:PERRICONE, KATHERINE ELIZABETH (BS, MA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:PERRICONE
Suffix:
Gender:F
Credentials:BS, MA
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:SAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SAGE
Mailing Address - Street 1:2615 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1654
Mailing Address - Country:US
Mailing Address - Phone:269-343-1651
Mailing Address - Fax:269-382-7078
Practice Address - Street 1:2615 STADIUM DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1654
Practice Address - Country:US
Practice Address - Phone:269-343-1651
Practice Address - Fax:269-382-7078
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator