Provider Demographics
NPI:1225553431
Name:RATTERMAN, KANDACE
Entity Type:Individual
Prefix:
First Name:KANDACE
Middle Name:
Last Name:RATTERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4814 KINGFISHER WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-2152
Mailing Address - Country:US
Mailing Address - Phone:502-999-5440
Mailing Address - Fax:
Practice Address - Street 1:4814 KINGFISHER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213
Practice Address - Country:US
Practice Address - Phone:502-999-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator