Provider Demographics
NPI:1629154901
Name:LANTHORN, KATHRYN JEAN (EDD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:JEAN
Last Name:LANTHORN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2308
Mailing Address - Country:US
Mailing Address - Phone:509-901-0806
Mailing Address - Fax:509-575-0758
Practice Address - Street 1:516 N 1ST ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2308
Practice Address - Country:US
Practice Address - Phone:509-901-0806
Practice Address - Fax:509-575-0758
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003927101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional