Provider Demographics
NPI:1619230943
Name:DEWEIN, KATHRYN MARGARET (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:MARGARET
Last Name:DEWEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:MARGARET
Other - Last Name:DEWEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:8510 STATE ROAD NN
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-7059
Mailing Address - Country:US
Mailing Address - Phone:573-590-2465
Mailing Address - Fax:
Practice Address - Street 1:8510 STATE ROAD NN
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-7059
Practice Address - Country:US
Practice Address - Phone:573-590-2465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01816103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling