Provider Demographics
NPI:1609345891
Name:WICHLAND, KATHLEEN (PSYD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:WICHLAND
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KATEY
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-0543
Mailing Address - Country:US
Mailing Address - Phone:603-387-9407
Mailing Address - Fax:
Practice Address - Street 1:70 COMMERCIAL ST STE 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5094
Practice Address - Country:US
Practice Address - Phone:603-387-9407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1560103TC1900X
CAPSB94024549390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program