Provider Demographics
NPI:1750726436
Name:AH WONG, KATHRYN KELLIE (MA, LPC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:KELLIE
Last Name:AH WONG
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18750 LEIMBACH RD
Mailing Address - Street 2:
Mailing Address - City:SAEGERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:16433-6826
Mailing Address - Country:US
Mailing Address - Phone:814-853-9112
Mailing Address - Fax:
Practice Address - Street 1:262 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3302
Practice Address - Country:US
Practice Address - Phone:814-332-0095
Practice Address - Fax:814-332-0081
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006879101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health