Provider Demographics
NPI:1508372574
Name:VAN GUNTEN, KATHRYN GRACE
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GRACE
Last Name:VAN GUNTEN
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 1:2593 QUEENSTON RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4351
Mailing Address - Country:US
Mailing Address - Phone:216-773-1194
Mailing Address - Fax:
Practice Address - Street 1:23400 E BAINTREE RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1248
Practice Address - Country:US
Practice Address - Phone:216-932-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician