Provider Demographics
NPI:1407457989
Name:CHEN, KATHERINE MYLENE
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:MYLENE
Last Name:CHEN
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 1:9701 DINO DR STE 170
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4042
Mailing Address - Country:US
Mailing Address - Phone:816-892-0013
Mailing Address - Fax:
Practice Address - Street 1:9701 DINO DR STE 170
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-4042
Practice Address - Country:US
Practice Address - Phone:916-892-0013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician