Provider Demographics
NPI:1689951824
Name:HODGES, KATHLEEN L (MS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:HODGES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:L
Other - Last Name:HAFLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1335 DUBLIN RD STE 212C
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7045
Mailing Address - Country:US
Mailing Address - Phone:614-437-9910
Mailing Address - Fax:
Practice Address - Street 1:1335 DUBLIN RD STE 212C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7045
Practice Address - Country:US
Practice Address - Phone:614-437-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0900270101Y00000X
OHE.0900270-SUPV101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor