Provider Demographics
NPI:1659874758
Name:BAILIN, KATHERINE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BAILIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8004 SILVERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-9434
Mailing Address - Country:US
Mailing Address - Phone:419-262-4892
Mailing Address - Fax:
Practice Address - Street 1:1446 REYNOLDS RD STE 301
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1634
Practice Address - Country:US
Practice Address - Phone:419-720-5800
Practice Address - Fax:419-720-4444
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1000231101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional