Provider Demographics
NPI:1588657803
Name:LEDET, KATHLEEN ANN (DC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:LEDET
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:1668 RT 715 SOUTH
Mailing Address - City:REEDERS
Mailing Address - State:PA
Mailing Address - Zip Code:18352-0500
Mailing Address - Country:US
Mailing Address - Phone:570-629-9220
Mailing Address - Fax:520-629-9188
Practice Address - Street 1:1668 RT 715 SOUTH
Practice Address - Street 2:
Practice Address - City:REEDERS
Practice Address - State:PA
Practice Address - Zip Code:18352
Practice Address - Country:US
Practice Address - Phone:570-629-9220
Practice Address - Fax:570-629-9188
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006603L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor