Provider Demographics
NPI:1508196635
Name:ST. JOHN, KATHLEEN (MM, MT-BC, NMT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:ST. JOHN
Suffix:
Gender:F
Credentials:MM, MT-BC, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 NORMAN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-1831
Mailing Address - Country:US
Mailing Address - Phone:719-213-4330
Mailing Address - Fax:719-352-3678
Practice Address - Street 1:830 TENDERFOOT HILL RD
Practice Address - Street 2:SUITE 150
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-2314
Practice Address - Country:US
Practice Address - Phone:719-213-4330
Practice Address - Fax:719-352-3678
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO06784225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist