Provider Demographics
NPI:1093843203
Name:LINDSTROM, KATHLEEN A (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:A
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3686 JOYCE ANN DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-3301
Mailing Address - Country:US
Mailing Address - Phone:330-793-7981
Mailing Address - Fax:
Practice Address - Street 1:841 BOARDMAN CANFIELD RD STE 307
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4230
Practice Address - Country:US
Practice Address - Phone:330-398-7787
Practice Address - Fax:330-776-5557
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6138103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000388708OtherANTHEM BLUE CROSS BLUE SH
OH2635018Medicaid
OH825300000OtherMAGELLAN BEHAVIORAL HEALT
OH560396OtherVALUE OPTIONS
OH2080945OtherCIGNA BEHAVIORAL HEALTH
OH372817OtherTRICARE - MHN