Provider Demographics
NPI:1679079420
Name:ZECKEL, KATHRYN F (PSYD HSPP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:F
Last Name:ZECKEL
Suffix:
Gender:F
Credentials:PSYD HSPP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:F
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD HSPP
Mailing Address - Street 1:432 ST JOHN RD # 100
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-7336
Mailing Address - Country:US
Mailing Address - Phone:219-561-0168
Mailing Address - Fax:
Practice Address - Street 1:617 FRANKLIN ST STE 7
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3411
Practice Address - Country:US
Practice Address - Phone:219-561-0168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043185A103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service