Provider Demographics
NPI:1013542463
Name:SLOM, KATHERINE LYN (101Y00000X)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LYN
Last Name:SLOM
Suffix:
Gender:F
Credentials:101Y00000X
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LYN
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:101Y00000X
Mailing Address - Street 1:7 ROYAL CREST DR APT 1
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6420
Mailing Address - Country:US
Mailing Address - Phone:978-879-3203
Mailing Address - Fax:
Practice Address - Street 1:345A GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01607-1753
Practice Address - Country:US
Practice Address - Phone:508-363-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty