Provider Demographics
NPI:1033229141
Name:SMITH, KATHERINE M (PH D)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:M
Other - Last Name:KLAWUNN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10761
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389
Mailing Address - Country:US
Mailing Address - Phone:661-834-8341
Mailing Address - Fax:661-834-6095
Practice Address - Street 1:5500 MING AVE
Practice Address - Street 2:STE 210
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:661-834-8341
Practice Address - Fax:661-834-6095
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11034103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPL110340Medicare ID - Type Unspecified