Provider Demographics
NPI:1679116362
Name:WHITEMAN, KATE
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:WHITEMAN
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 1:3684 DISMORE RD
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-8302
Mailing Address - Country:US
Mailing Address - Phone:563-272-9603
Mailing Address - Fax:
Practice Address - Street 1:1441 W CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-1707
Practice Address - Country:US
Practice Address - Phone:563-383-1900
Practice Address - Fax:563-328-5690
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
COACD.0001495101YA0400X
IAT20043101YA0400X
COMFT.0002048106H00000X
COMFTC.0013980106H00000X
IA101067106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)