Provider Demographics
NPI:1578949772
Name:HODGE, KATHERINE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:HODGE
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 1:3091 S PINES DR
Mailing Address - Street 2:APT. 63
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3223
Mailing Address - Country:US
Mailing Address - Phone:619-822-8207
Mailing Address - Fax:
Practice Address - Street 1:3091 S PINES DR
Practice Address - Street 2:APT. 63
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3223
Practice Address - Country:US
Practice Address - Phone:619-822-8207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst