Provider Demographics
NPI:1548361207
Name:KOEPELE, KATHLEEN CRONE (M) (CLINICAL SOCIAL WORK)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:CRONE (M)
Last Name:KOEPELE
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 CENTER FAYSTON RD
Mailing Address - Street 2:
Mailing Address - City:MORETOWN
Mailing Address - State:VT
Mailing Address - Zip Code:05660-9365
Mailing Address - Country:US
Mailing Address - Phone:802-583-1799
Mailing Address - Fax:802-583-1799
Practice Address - Street 1:3400 CENTER FAYSTON RD
Practice Address - Street 2:
Practice Address - City:MORETOWN
Practice Address - State:VT
Practice Address - Zip Code:05660-9365
Practice Address - Country:US
Practice Address - Phone:802-583-1799
Practice Address - Fax:802-583-1799
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010095491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0890397Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER