Provider Demographics
NPI:1598343931
Name:OSMUNDSON, KATHARINE MERADITH (RBT)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:MERADITH
Last Name:OSMUNDSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 S BOULDER CT UNIT F
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3777
Mailing Address - Country:US
Mailing Address - Phone:480-250-8134
Mailing Address - Fax:
Practice Address - Street 1:2451 E BASELINE RD STE 300
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2465
Practice Address - Country:US
Practice Address - Phone:480-474-4173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRBT-21-162181106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician