Provider Demographics
NPI:1225211733
Name:RODEHORST, KATIE LYNN (KATIE RODEHORST)
Entity Type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:LYNN
Last Name:RODEHORST
Suffix:
Gender:F
Credentials:KATIE RODEHORST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 GLENWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-6707
Mailing Address - Country:US
Mailing Address - Phone:408-313-2991
Mailing Address - Fax:
Practice Address - Street 1:502 KING ST
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-3232
Practice Address - Country:US
Practice Address - Phone:831-385-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4863174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist