Provider Demographics
NPI:1609417559
Name:TESTON, KATHRYN RAE
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:RAE
Last Name:TESTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:RAE
Other - Last Name:BRUMBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10330 HICKMAN MILLS DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64137-1618
Mailing Address - Country:US
Mailing Address - Phone:816-501-5138
Mailing Address - Fax:
Practice Address - Street 1:14844 W 107TH ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-4002
Practice Address - Country:US
Practice Address - Phone:720-575-9340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3075103K00000X
MO2023013821103K00000X
KS00549103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst