Provider Demographics
NPI:1366777328
Name:OSBORNE, KATHLEEN (PHD, PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:PHD, PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:615 E 82ND AVE
Mailing Address - Street 2:STUITE 102
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-3100
Mailing Address - Country:US
Mailing Address - Phone:907-344-3338
Mailing Address - Fax:907-344-8020
Practice Address - Street 1:615 E 82ND AVE
Practice Address - Street 2:STUITE 102
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-3100
Practice Address - Country:US
Practice Address - Phone:907-344-3338
Practice Address - Fax:907-344-8020
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK543101YP2500X
AKPSYS116103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional