Provider Demographics
NPI:1528407665
Name:YODER, KATIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:
Last Name:YODER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8129 COURTYARD LOOP
Mailing Address - Street 2:APT 9
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-4770
Mailing Address - Country:US
Mailing Address - Phone:435-200-5525
Mailing Address - Fax:
Practice Address - Street 1:1750 SUN PEAK DR
Practice Address - Street 2:SUITE 175
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-6724
Practice Address - Country:US
Practice Address - Phone:435-200-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8450689-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist