Provider Demographics
NPI:1487079273
Name:STEVENS, KATHRYN (M ED, ED S, NCSP)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:M ED, ED S, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-2302
Mailing Address - Country:US
Mailing Address - Phone:330-385-7132
Mailing Address - Fax:330-382-7671
Practice Address - Street 1:810 W 8TH ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-2302
Practice Address - Country:US
Practice Address - Phone:330-385-7132
Practice Address - Fax:330-382-7671
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3129683103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool