Provider Demographics
NPI:1003035072
Name:REDWOOD, KATHRYN SUE (MFT MA)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:SUE
Last Name:REDWOOD
Suffix:
Gender:F
Credentials:MFT MA
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:SUE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE H
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482
Mailing Address - Country:US
Mailing Address - Phone:707-468-7860
Mailing Address - Fax:707-468-7860
Practice Address - Street 1:530 SOUTH MAIN STREET
Practice Address - Street 2:SUITE H
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482
Practice Address - Country:US
Practice Address - Phone:707-468-7860
Practice Address - Fax:707-468-7860
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29223106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA29223OtherBBSE MFT NUMBER