Provider Demographics
NPI:1437792819
Name:BENNETT, KATHRINE LYNN
Entity Type:Individual
Prefix:
First Name:KATHRINE
Middle Name:LYNN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRINE
Other - Middle Name:LYNN
Other - Last Name:DREIBELBIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2233 ROCKY LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-4701
Mailing Address - Country:US
Mailing Address - Phone:419-281-3716
Mailing Address - Fax:419-281-4605
Practice Address - Street 1:2233 ROCKY LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4701
Practice Address - Country:US
Practice Address - Phone:419-281-3716
Practice Address - Fax:419-281-4605
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty