Provider Demographics
NPI:1518655604
Name:HOUSH, KATHRYN J (RDH)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:J
Last Name:HOUSH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:J
Other - Last Name:MARBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:901 MACY DR
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-3102
Mailing Address - Country:US
Mailing Address - Phone:417-214-2158
Mailing Address - Fax:
Practice Address - Street 1:2209 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-9092
Practice Address - Country:US
Practice Address - Phone:417-451-0977
Practice Address - Fax:417-451-7094
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023014634124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist