Provider Demographics
NPI:1043498975
Name:LIST, ILKA KATHERINE (MFA , DA, RCAT)
Entity Type:Individual
Prefix:DR
First Name:ILKA
Middle Name:KATHERINE
Last Name:LIST
Suffix:
Gender:F
Credentials:MFA , DA, RCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 SPRINGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-3032
Mailing Address - Country:US
Mailing Address - Phone:845-255-1134
Mailing Address - Fax:
Practice Address - Street 1:428 SPRINGTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-3032
Practice Address - Country:US
Practice Address - Phone:845-255-1134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000963102X00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist