Provider Demographics
NPI:1689724031
Name:ZIELESCH, KATHRYN A (PH D)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:A
Last Name:ZIELESCH
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:DR
Other - First Name:KIANNA
Other - Middle Name:
Other - Last Name:ZIELESCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PH D
Mailing Address - Street 1:1315 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-3906
Mailing Address - Country:US
Mailing Address - Phone:707-841-7057
Mailing Address - Fax:844-264-9422
Practice Address - Street 1:1315 CEDAR ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-3906
Practice Address - Country:US
Practice Address - Phone:707-841-7057
Practice Address - Fax:707-841-7057
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist