Provider Demographics
NPI:1790111995
Name:KIVISTO, KATHERINE LITTLE (PHD, HSPP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LITTLE
Last Name:KIVISTO
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:CLAIRE
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 E HANNA AVE
Mailing Address - Street 2:GOOD HALL 109
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-3630
Mailing Address - Country:US
Mailing Address - Phone:317-788-3790
Mailing Address - Fax:
Practice Address - Street 1:1400 E HANNA AVE
Practice Address - Street 2:GOOD HALL 109
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-3630
Practice Address - Country:US
Practice Address - Phone:317-788-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042671A103TC0700X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily