Provider Demographics
NPI:1245801968
Name:LEHTO, KATIE MARIE
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:MARIE
Last Name:LEHTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MARIE
Other - Last Name:LEHTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9801 OLD BAYMEADOWS RD APT 118
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8129
Mailing Address - Country:US
Mailing Address - Phone:904-881-3416
Mailing Address - Fax:
Practice Address - Street 1:9801 OLD BAYMEADOWS RD APT 118
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-8129
Practice Address - Country:US
Practice Address - Phone:904-881-3416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-03
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator