Provider Demographics
NPI:1013578780
Name:BADGEROW, KATHERINE LEEANNE (SUD-RC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LEEANNE
Last Name:BADGEROW
Suffix:
Gender:F
Credentials:SUD-RC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SUN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3714
Mailing Address - Country:US
Mailing Address - Phone:831-682-3408
Mailing Address - Fax:831-753-6007
Practice Address - Street 1:8 SUN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3714
Practice Address - Country:US
Practice Address - Phone:831-753-5145
Practice Address - Fax:831-753-6007
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12891101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACCAPPOtherREGISTERED ADDICTION SPECIALIST