Provider Demographics
NPI:1447568720
Name:GANNON, KATHARINE ANNE (MA)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:ANNE
Last Name:GANNON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 S BIRCH ST
Mailing Address - Street 2:APT. # 702
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4110
Mailing Address - Country:US
Mailing Address - Phone:708-415-5293
Mailing Address - Fax:
Practice Address - Street 1:5524 S PRINCE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-1126
Practice Address - Country:US
Practice Address - Phone:303-761-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health