Provider Demographics
NPI:1710670260
Name:KISSLING, KATELYNN JOAN
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:JOAN
Last Name:KISSLING
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 1:2047 PA ROUTE 309
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9307
Mailing Address - Country:US
Mailing Address - Phone:484-276-4646
Mailing Address - Fax:484-558-2998
Practice Address - Street 1:2047 PA ROUTE 309
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9307
Practice Address - Country:US
Practice Address - Phone:484-276-4646
Practice Address - Fax:484-558-2998
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker