Provider Demographics
NPI:1093032559
Name:TRUNNELL, KATHRYN JOSEPHINE (CATC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JOSEPHINE
Last Name:TRUNNELL
Suffix:
Gender:F
Credentials:CATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 S HAM LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-3525
Mailing Address - Country:US
Mailing Address - Phone:209-224-8940
Mailing Address - Fax:
Practice Address - Street 1:441 S HAM LN
Practice Address - Street 2:SUITE A
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3525
Practice Address - Country:US
Practice Address - Phone:209-224-8940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)