Provider Demographics
NPI:1437520939
Name:WAMMACK, KATHLEEN MARIE
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:WAMMACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:WAMMACK-UCYILDIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MB
Mailing Address - Street 1:7004 GOLDEN DESERT AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7114
Mailing Address - Country:US
Mailing Address - Phone:702-326-3421
Mailing Address - Fax:
Practice Address - Street 1:7004 GOLDEN DESERT AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7114
Practice Address - Country:US
Practice Address - Phone:702-326-3421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-10
Last Update Date:2015-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst