1700863008 NPI number — DR. KATHERINE SUSAN REARDEN LCSW, ACSW, BCD

Table of content: DR. KATHERINE SUSAN REARDEN LCSW, ACSW, BCD (NPI 1700863008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700863008 NPI number — DR. KATHERINE SUSAN REARDEN LCSW, ACSW, BCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REARDEN
Provider First Name:
KATHERINE
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, ACSW, BCD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REARDEN
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
PALEMRE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW, ACSW, BCD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1700863008
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4060 N FERNHILL CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85750-2414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-298-8543
Provider Business Mailing Address Fax Number:
520-228-5283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5380 E KACHINA ST
Provider Second Line Business Practice Location Address:
DAVIS-MONTHAN AFB
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85707-4923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-228-4926
Provider Business Practice Location Address Fax Number:
520-228-5283
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  2593 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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