1891036299 NPI number — DR. KATHERINE JILL WALDEN PH.D.

Table of content: DR. KATHERINE JILL WALDEN PH.D. (NPI 1891036299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891036299 NPI number — DR. KATHERINE JILL WALDEN PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALDEN
Provider First Name:
KATHERINE
Provider Middle Name:
JILL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ENGLAND
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
JILL
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891036299
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11312 SILVER WILLOW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEVADA CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95959-9541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-302-2764
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11899 EDGEWOOD RD
Provider Second Line Business Practice Location Address:
G
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95603-3437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-302-2764
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2013

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: 103TC0700X , with the licence number:  PSY 18936 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com