Provider Demographics
NPI:1255693495
Name:BOMBARD, KATHERINE (MS, ED)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:BOMBARD
Suffix:
Gender:F
Credentials:MS, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3812
Mailing Address - Country:US
Mailing Address - Phone:518-272-2236
Mailing Address - Fax:
Practice Address - Street 1:21 1ST ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3812
Practice Address - Country:US
Practice Address - Phone:518-272-2236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY595602051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist