| Doctor Name: | MRS. KIM KATHLEEN GREEN |
| NPI Number: | 1083627392 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMSW |
| License Number: | 6802079325 |
| Business Practice Address: | 787 Market Street Hancock, MI - 49930 |
| Business Phone Number: | 9064827762 |
| Business Fax Number: | 9064827893 |
| Mailing Address: | 325 East 'h' Street, IRON MOUNTAIN |
| State: | MI |
| Postal Code: | 49801 |
| Phone Number: | 9067743300 |
| Fax Number: | 9067793148 |
| NPI Enumeration Date: | 08/15/2006 |
| NPI Last Update Date: | 07/02/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 6802079325 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |