Provider Demographics
NPI:1679285274
Name:LOHSE, KATHRYN
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:LOHSE
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 1:928 SUSSEX RD
Mailing Address - Street 2:
Mailing Address - City:KAYCEE
Mailing Address - State:WY
Mailing Address - Zip Code:82639-9618
Mailing Address - Country:US
Mailing Address - Phone:307-760-1096
Mailing Address - Fax:
Practice Address - Street 1:928 SUSSEX RD
Practice Address - Street 2:
Practice Address - City:KAYCEE
Practice Address - State:WY
Practice Address - Zip Code:82639-9618
Practice Address - Country:US
Practice Address - Phone:307-760-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY77443101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool