Provider Demographics
NPI:1316355084
Name:ANDERSON, KATELYN H (MED)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:H
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:HANCIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7599 BETH BATH PIKE
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:PA
Mailing Address - Zip Code:18014
Mailing Address - Country:US
Mailing Address - Phone:610-365-8373
Mailing Address - Fax:
Practice Address - Street 1:7599 BETH BATH PIKE
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:PA
Practice Address - Zip Code:18014
Practice Address - Country:US
Practice Address - Phone:610-365-8989
Practice Address - Fax:610-365-8994
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000169103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABH000169OtherBEHAVIOR SPECIALIST